Provider Demographics
NPI:1588899926
Name:LIVE WELL CHIROPRACTIC
Entity type:Organization
Organization Name:LIVE WELL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:DYE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-288-5455
Mailing Address - Street 1:1250 E BUSINESS HIGHWAY 151
Mailing Address - Street 2:SUITE I
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3875
Mailing Address - Country:US
Mailing Address - Phone:636-288-5455
Mailing Address - Fax:
Practice Address - Street 1:1250 E BUSINESS HIGHWAY 151
Practice Address - Street 2:SUITE I
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3875
Practice Address - Country:US
Practice Address - Phone:636-288-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty