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General NPI Number Information
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NPI Number | 1124445556
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Entity Type | Organization
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Legal Business Name | LIVING LIFE WELL CHIROPRACTIC, INC
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 403 SHADRACK ST
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City | WAYNESBORO
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State | GA
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Zip | 30830-1540
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Country | US
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Telephone | 706-437-1170
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Fax | 706-437-1163
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Provider Business Mailing Address
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Address Line | 403 SHADRACK ST
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City | WAYNESBORO
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State | GA
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Zip | 30830-1540
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Country | US
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Telephone | 706-437-1170
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Fax | 706-437-1163
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MIGNON SWEAT
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Credential | D.C., M.S.
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Telephone | 706-437-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 8614
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License Number State | GA
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