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General NPI Number Information
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NPI Number | 1215130539
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Entity Type | Organization
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Legal Business Name | HEATLHY LIFESTYLES WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 38 COURT SQ
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City | WEST PLAINS
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State | MO
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Zip | 65775-3445
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Country | US
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Telephone | 417-256-4592
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Fax | 417-256-4596
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Provider Business Mailing Address
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Address Line | 38 COURT SQ
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City | WEST PLAINS
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State | MO
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Zip | 65775-3445
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Country | US
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Telephone | 417-256-4592
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Fax | 417-256-4596
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. CAMELLIA NATAY SVUBA
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Credential | D.C.
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Telephone | 417-256-4592
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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 | 2007013671
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License Number State | MO
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