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General NPI Number Information
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NPI Number | 1497021869
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Entity Type | Organization
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Legal Business Name | LIVING WELL PLLC
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 771 CORPORATE DRIVE SUITE 610
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City | LEXINGTON
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State | KY
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Zip | 40503-5440
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Country | US
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Telephone | 859-410-8550
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Fax | 859-223-0642
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Provider Business Mailing Address
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Address Line | PO BOX 910544
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City | LEXINGTON
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State | KY
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Zip | 40591-0544
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Country | US
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Telephone | 859-410-8550
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Fax | 859-223-0642
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MAX HAMMOND
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Credential |
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Telephone | 859-410-8550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 33755
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License Number State | KY
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