Provider Demographics
NPI:1104325067
Name:MOVEWELL CHIROPRACTIC & BODYWORKS LLC
Entity type:Organization
Organization Name:MOVEWELL CHIROPRACTIC & BODYWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-247-6034
Mailing Address - Street 1:9320 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9320 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2555
Practice Address - Country:US
Practice Address - Phone:316-247-6034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty