Provider Demographics
NPI:1750759072
Name:LIVE HEALTHY PA
Entity type:Organization
Organization Name:LIVE HEALTHY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MASSOGLIA
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:651-334-1290
Mailing Address - Street 1:7300 147TH ST W
Mailing Address - Street 2:UNIT 304
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7541
Mailing Address - Country:US
Mailing Address - Phone:952-431-5330
Mailing Address - Fax:651-528-6882
Practice Address - Street 1:7300 147TH ST W
Practice Address - Street 2:UNIT 304
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7541
Practice Address - Country:US
Practice Address - Phone:952-431-5330
Practice Address - Fax:651-528-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2728111N00000X, 111NS0005X
MN43602207QA0401X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty