Provider Demographics
NPI:1780093013
Name:LIVING WELL CHIROPRACTIC, PC
Entity type:Organization
Organization Name:LIVING WELL CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-827-7063
Mailing Address - Street 1:627 NW NORTH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WAUKOMIS
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1449
Mailing Address - Country:US
Mailing Address - Phone:913-827-7063
Mailing Address - Fax:
Practice Address - Street 1:627 NW NORTH SHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE WAUKOMIS
Practice Address - State:MO
Practice Address - Zip Code:64151-1449
Practice Address - Country:US
Practice Address - Phone:913-827-7063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010040039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty