Provider Demographics
NPI:1841626868
Name:LIVE WELL CHIROPRACTIC, PC
Entity type:Organization
Organization Name:LIVE WELL CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-274-7484
Mailing Address - Street 1:6809 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2569
Mailing Address - Country:US
Mailing Address - Phone:605-274-7484
Mailing Address - Fax:605-274-7486
Practice Address - Street 1:6809 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2569
Practice Address - Country:US
Practice Address - Phone:605-274-7484
Practice Address - Fax:605-274-7486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty