Healthcare Provider Details

I. General information

NPI: 1376585133
Provider Name (Legal Business Name): LIVING WELL CHIROPRACTIC INC. PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date: 07/11/2022
Reactivation Date: 08/29/2022

III. Provider practice location address

1412 E YELM AV C101
YELM WA
98597
US

IV. Provider business mailing address

1412 E YELM AV C101
YELM WA
98597
US

V. Phone/Fax

Practice location:
  • Phone: 360-458-7533
  • Fax:
Mailing address:
  • Phone: 360-458-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034456
License Number StateWA

VIII. Authorized Official

Name: DR. MATTHEW ALAN SINGH
Title or Position: PRESIDENT
Credential: DC
Phone: 503-332-1024