NPIMap

Organization Active NPI

Live Young PLLC

Doing business as Live Young Chiropractic

  • Primary Care Clinic/Center
  • Port St Lucie, FL
National Provider Identifier
1073962114
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
CH11346 Issued in FL
Legal business name
LIVE YOUNG PLLC
Doing business as
Live Young Chiropractic
Practice address
1680 SW Saint Lucie West Blvd Ste 204
Port St Lucie, FL 34986-1927
Phone
(772) 212-1111
Fax
(772) 212-0201
NPI assigned
Jun 9, 2016
Last updated
Feb 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Authorized official

Name
Dr. Timothy M Kennedy, DCNPI 1750787586
Title
Owner
Phone
(772) 212-1111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X CH11346 FL Primary

Addresses

Primary practice location

1680 SW Saint Lucie West Blvd Ste 204
Port St Lucie, FL 34986-1927

Mailing address

318 SE Fisk Rd
Port St Lucie, FL 34984-8920
Phone (860) 883-5850

Other names 1

  • Live Young Chiropractic Doing business as

National Provider Directory

National Provider Directory

Locations

1680 SW Saint Lucie West Blvd
Ste 204
Port St Lucie, FL 34986
Phone (772) 212-1111

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549929600000",
    "number": "1073962114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 SE FISK RD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349848920",
            "telephone_number": "860-883-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 SW SAINT LUCIE WEST BLVD STE 204",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861927",
            "telephone_number": "772-212-1111",
            "fax_number": "772-212-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE YOUNG PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-09",
        "last_updated": "2019-02-12",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-212-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "CH11346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Live Young Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Live Young Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.