Provider Demographics
NPI:1871728394
Name:LIVING LIFE CHIROPRACTIC, INC
Entity type:Organization
Organization Name:LIVING LIFE CHIROPRACTIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-225-7414
Mailing Address - Street 1:221 6TH AVE SE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4362
Mailing Address - Country:US
Mailing Address - Phone:605-225-7414
Mailing Address - Fax:605-225-7693
Practice Address - Street 1:221 6TH AVE SE
Practice Address - Street 2:SUITE 3
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4362
Practice Address - Country:US
Practice Address - Phone:605-225-7414
Practice Address - Fax:605-225-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty