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General NPI Number Information
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NPI Number | 1821260621
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Entity Type | Organization
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Legal Business Name | LIVE WELL CHIROPRACTIC AND WELLNESS CENTER
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 749 LONESOME DOVE TRL
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City | HURST
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State | TX
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Zip | 76054-6018
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Country | US
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Telephone | 817-485-9355
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Fax | 817-427-9355
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Provider Business Mailing Address
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Address Line | 749 LONESOME DOVE TRL
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City | HURST
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State | TX
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Zip | 76054-6018
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Country | US
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Telephone | 817-485-9355
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Fax | 817-427-9355
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JENIIFER E RIDLEY
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Credential | D.C.
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Telephone | 817-485-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 10449
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License Number State | TX
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