Healthcare Provider Details

I. General information

NPI: 1346540960
Provider Name (Legal Business Name): LIVE WELL CHIROPRACTIC CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E WASHINGTON ST
ANN ARBOR MI
48104-2008
US

IV. Provider business mailing address

204 E WASHINGTON ST
ANN ARBOR MI
48104-2008
US

V. Phone/Fax

Practice location:
  • Phone: 734-546-4036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2301009666
License Number StateMI

VIII. Authorized Official

Name: DR. MARK EDWARD CHAPPELL-LAKIN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 734-546-4036