Provider Demographics
NPI:1871600262
Name:LIVING WELLNESS CHIROPRATIC,LLC
Entity type:Organization
Organization Name:LIVING WELLNESS CHIROPRATIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUNTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-524-6600
Mailing Address - Street 1:220 W COLD SPRING LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2802
Mailing Address - Country:US
Mailing Address - Phone:443-524-6600
Mailing Address - Fax:
Practice Address - Street 1:220 W COLD SPRING LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2802
Practice Address - Country:US
Practice Address - Phone:443-524-6600
Practice Address - Fax:443-524-6608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF697OtherBLUE CHOICE FED
MDLX90LIOtherBC/BS PROVIDER
MDLX90LIOtherBC/BS PROVIDER