Provider Demographics
NPI:1730335225
Name:LIVE WELL CHIROPRACTIC , P.C.
Entity type:Organization
Organization Name:LIVE WELL CHIROPRACTIC , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-731-9899
Mailing Address - Street 1:3384 W 4600 S STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9222
Mailing Address - Country:US
Mailing Address - Phone:801-731-9899
Mailing Address - Fax:801-731-9897
Practice Address - Street 1:3384 W 4600 S STE 1
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9222
Practice Address - Country:US
Practice Address - Phone:801-731-9899
Practice Address - Fax:801-731-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty