Provider Demographics
NPI:1952758674
Name:LIVE WELL BE WELL LLC
Entity Type:Organization
Organization Name:LIVE WELL BE WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-357-2601
Mailing Address - Street 1:14784 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3708
Mailing Address - Country:US
Mailing Address - Phone:419-357-2601
Mailing Address - Fax:
Practice Address - Street 1:14784 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3708
Practice Address - Country:US
Practice Address - Phone:419-357-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty