NPIMap

Organization Active NPI

Live Well Chiropractic

  • Physical Therapist
  • Brainerd, MN
National Provider Identifier
1942620570
Registry record updated Jun 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6561 Issued in MN
Legal business name
LIVE WELL CHIROPRACTIC
Practice address
315 E River Rd
Brainerd, MN 56401-3503
Phone
(218) 454-5483
Fax
(218) 454-5484
NPI assigned
Apr 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2014

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

Authorized official

Name
Dr. James Davis, DCNPI 1508970344
Title
Owner
Phone
(121) 454-5483

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 3549 MN
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 6561 MN Primary

Addresses

Primary practice location

315 E River Rd
Brainerd, MN 56401-3503

Mailing address

315 E River Rd
Brainerd, MN 56401-3503
Phone (218) 454-5483

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140623002070 MN Part B Supplier - Clinic/Group Practice 3779707278 Receives reassigned benefits from 3 practitioners
Practice locations: Brainerd, MN

National Provider Directory

National Provider Directory

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": "1398124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401667200000",
    "number": "1942620570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E RIVER RD",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013503",
            "telephone_number": "218-454-5483",
            "fax_number": "218-454-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E RIVER RD",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013503",
            "telephone_number": "218-454-5483",
            "fax_number": "218-454-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE WELL CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-22",
        "last_updated": "2014-06-02",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "121-454-5483",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3549",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "6561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brainerd, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2014; 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.