Provider Demographics
NPI:1083980981
Name:HEALTHY LIVING CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:HEALTHY LIVING CHIROPRACTIC CLINIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE-ANDREE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GELINAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-865-7225
Mailing Address - Street 1:858 HANSEN RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5324
Mailing Address - Country:US
Mailing Address - Phone:920-497-9557
Mailing Address - Fax:
Practice Address - Street 1:560 CENTENNIAL CENTRE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:WI
Practice Address - Zip Code:54155-8918
Practice Address - Country:US
Practice Address - Phone:920-865-7225
Practice Address - Fax:920-865-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4320012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38979100Medicaid