MEDICARE: LIVE WELL CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3698	OR

General Provider Information

NPI Number	:	1629316708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE WELL CHIROPRACTIC

Provider Business Mailing Address
First Line	:	20229 HIGHWAY 213
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-9069
Country	:	US
Telephone Number	:	503-342-2719
Fax Number	:	503-305-3263

Provider Business Practice Location Address
First Line	:	20229 HIGHWAY 213
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-9069
Country	:	US
Telephone Number	:	503-342-2719
Fax Number	:	503-305-3263

Authorized Official
Title or Position	:	OWNER
Name	:	NATHAN EDMONDS
Credential	:
Telephone Number	:	503-342-2719

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	01/23/2013

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Directions to “LIVE WELL CHIROPRACTIC ” Practice Location

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