Life Enhancing Wellness Centers, LLC

Primary specialty

Nutrition ChiropractorTaxonomy code 111NN1001X

License

0104556817 Issued in VA

Legal business name

LIFE ENHANCING WELLNESS CENTERS, LLC

Practice address

8881 Seminole TRL
Ruckersville, VA 22968-3448

Phone

(434) 481-2012

NPI assigned

Feb 13, 2017

Last updated

Nov 14, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Demetrios A Kydonieus, DCNPI 1316009301

Title

Owner

Phone

(434) 481-2012

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Demetrios Agis Kydonieus, DC

  • Chiropractor
  • Belvidere, NJ
  • NPI 1316009301

  VA

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542153600000",
    "number": "1043759863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8881 SEMINOLE TRL",
            "city": "RUCKERSVILLE",
            "state": "VA",
            "postal_code": "229683448",
            "telephone_number": "434-481-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8881 SEMINOLE TRL",
            "city": "RUCKERSVILLE",
            "state": "VA",
            "postal_code": "229683448",
            "telephone_number": "434-481-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ENHANCING WELLNESS CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2018-11-14",
        "status": "A",
        "authorized_official_last_name": "KYDONIEUS",
        "authorized_official_first_name": "DEMETRIOS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "434-481-2012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": "VA",
            "license": "0104556817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pamela Lamb
• Shari Lyn Landry, OTR/L
• Leah A Lawson, M.S., CCC-SLP
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• Micah Garrett Lindsey
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• Susana Lopez, DDS
• Kayla Marie Magnone, FNP

• Nutrition Chiropractor in Ruckersville, VA
• Providers in Ruckersville, VA by specialty
• Nutrition Chiropractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.