NPIMap

Organization Active NPI

Live for Wellness Chiropractic Center

  • Chiropractor
  • Charleston, SC
National Provider Identifier
1275882995
Registry record updated Sep 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3757 Issued in SC
Legal business name
LIVE FOR WELLNESS CHIROPRACTIC CENTER
Practice address
3417 Shelby Ray CT
Suite C
Charleston, SC 29414-5895
Phone
(843) 556-6000
NPI assigned
Sep 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2012

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

Authorized official

Name
Dr. Jennifer L Perdue, D.C.NPI 1790031961
Title
Doctor of Chiropractic/Owner
Phone
(920) 960-2425

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3757 SC Primary

Addresses

Primary practice location

3417 Shelby Ray CT
Suite C
Charleston, SC 29414-5895

Mailing address

3417 Shelby Ray CT
Suite C
Charleston, SC 29414-5895
Phone (843) 556-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121015000307 SC Part B Supplier - Clinic/Group Practice 9335399039 Receives reassigned benefits from 3 practitioners
Practice locations: Charleston, SC

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347235200000",
    "number": "1275882995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3417 SHELBY RAY CT",
            "address_2": "SUITE C",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145895",
            "telephone_number": "843-556-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 SHELBY RAY CT",
            "address_2": "SUITE C",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145895",
            "telephone_number": "843-556-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE FOR WELLNESS CHIROPRACTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-10",
        "last_updated": "2012-09-10",
        "status": "A",
        "authorized_official_last_name": "PERDUE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC/OWNER",
        "authorized_official_telephone_number": "920-960-2425",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "3757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; 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.