MEDICARE: LIVE WELL CHIROPRACTIC LLC

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	964038	AK

General Provider Information

NPI Number	:	1700307733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE WELL CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	110 W TUDOR RD STE D
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7247
Country	:	US
Telephone Number	:	907-334-6492
Fax Number	:	907-334-5829

Provider Business Practice Location Address
First Line	:	110 W TUDOR RD STE D
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7247
Country	:	US
Telephone Number	:	907-334-6492
Fax Number	:	907-334-5829

Authorized Official
Title or Position	:	OWNER
Name	:	TORY FREEMAN
Credential	:	DC
Telephone Number	:	907-344-6492

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	07/21/2022

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