Provider Demographics
NPI:1871783845
Name:LIVINGWELL INTEGRATIVE HEALTHCARE
Entity type:Organization
Organization Name:LIVINGWELL INTEGRATIVE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-850-9988
Mailing Address - Street 1:838 POWDERSVILLE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3703
Mailing Address - Country:US
Mailing Address - Phone:864-855-9988
Mailing Address - Fax:864-850-9989
Practice Address - Street 1:838 POWDERSVILLE RD
Practice Address - Street 2:SUITE G
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3703
Practice Address - Country:US
Practice Address - Phone:864-855-9988
Practice Address - Fax:864-850-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QM2500X261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC15727OtherSTATE LICENSE
SCE96419Medicare PIN