Life Enhancing Wellness Centers, LLC
Organization Active NPI Nutrition Chiropractor · Ruckersville, VA
NPI 1043759863 · NPPES record last updated Nov 14, 2018
Key facts
- NPI
- 1043759863
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nutrition Chiropractor 111NN1001X
- License
- 0104556817 (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
- Organization subpart
- No
Authorized official
- Name
- Dr. Demetrios A Kydonieus, DC
- Title
- Owner
- Phone
- (434) 481-2012
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190123000872 | VA | Part B Supplier - Clinic/Group Practice | 4587901053 |
Receives reassigned benefits from 1 practitioner Practice locations: Ruckersville, VA |
National Provider Directory
Locations
8218 Seminole Trl
Ruckersville, VA 22968
Phone (434) 481-2012
8881 Seminole Trl
Ruckersville, VA 22968
Phone (434) 481-2012
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Chiropractor |
111NN1001X | 0104556817 | VA | Yes |
Addresses
Primary practice location
8881 Seminole TRL
Ruckersville, VA 22968-3448
Mailing address
8881 Seminole TRL
Ruckersville, VA 22968-3448
Phone (434) 481-2012
Other providers in Ruckersville, VA
- KKCL Healthcare LLC
- William T Laffond
- Pamela Lamb
- Shari Lyn Landry
- Leah A Lawson
- Life Works Professional Counseling, PLLC
- Micah Garrett Lindsey
- Livinrite Home Health Services of Central Virginia LLC
- Susana Lopez
- Kayla Marie Magnone
All providers in Ruckersville, VA · Nutrition Chiropractor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.