Healthcare Provider Details

I. General information

NPI: 1083980981
Provider Name (Legal Business Name): HEALTHY LIVING CHIROPRACTIC CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CENTENNIAL CENTRE BLVD STE 150
ONEIDA WI
54155-8918
US

IV. Provider business mailing address

858 HANSEN RD
GREEN BAY WI
54304-5324
US

V. Phone/Fax

Practice location:
  • Phone: 920-865-7225
  • Fax: 920-865-7224
Mailing address:
  • Phone: 920-497-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4320012
License Number StateWI

VIII. Authorized Official

Name: DR. MARIE-ANDREE C GELINAS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 920-865-7225