Provider Demographics
NPI:1740681857
Name:LIVING WELL PAIN CLINICS PLLC
Entity type:Organization
Organization Name:LIVING WELL PAIN CLINICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER / OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-842-4929
Mailing Address - Street 1:19265 STATE ROUTE 2
Mailing Address - Street 2:STE 200A
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19265 STATE ROUTE 2
Practice Address - Street 2:STE 200A
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1522
Practice Address - Country:US
Practice Address - Phone:206-842-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty