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General NPI Number Information
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NPI Number | 1134302490
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Entity Type | Organization
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Legal Business Name | LIVE WELL CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 1035 JUNIPER ST NE
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City | ATLANTA
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State | GA
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Zip | 30309-4012
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Country | US
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Telephone | 404-235-0995
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Fax |
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Provider Business Mailing Address
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Address Line | 1035 JUNIPER ST NE
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City | ATLANTA
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State | GA
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Zip | 30309-4012
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Country | US
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Telephone | 404-235-0995
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CHIROPRACTOR
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Name | KRISTY MARIE FRANCAVILLA
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Credential |
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Telephone | 404-235-0995
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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 | CHIR006309
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License Number State | GA
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