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General NPI Number Information
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NPI Number | 1043759863
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Entity Type | Organization
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Legal Business Name | LIFE ENHANCING WELLNESS CENTERS, LLC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 8881 SEMINOLE TRL
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City | RUCKERSVILLE
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State | VA
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Zip | 22968-3448
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Country | US
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Telephone | 434-481-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 8881 SEMINOLE TRL
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City | RUCKERSVILLE
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State | VA
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Zip | 22968-3448
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Country | US
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Telephone | 434-481-2012
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEMETRIOS A KYDONIEUS
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Credential | DC
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Telephone | 434-481-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 0104556817
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License Number State | VA
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