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General NPI Number Information
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NPI Number | 1184850356
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Entity Type | Organization
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Legal Business Name | LIVE WELL FOR LIFE, LLC
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 4495 BAYMEADOWS RD STE 9
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4716
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Country | US
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Telephone | 904-425-8070
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Fax |
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Provider Business Mailing Address
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Address Line | 410-9 BLANDING BLVD 321
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City | ORANGE PARK
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State | FL
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Zip | 32073
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Country | US
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Telephone | 904-425-8070
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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. NICOLE ANZALONE
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Credential | D.C
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Telephone | 904-425-8070
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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 | CH9636
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License Number State | FL
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