Provider Demographics
NPI:1487094769
Name:HARMONIOUS LIVING CHIROPRACTIC: FITNESS & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:HARMONIOUS LIVING CHIROPRACTIC: FITNESS & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-695-6045
Mailing Address - Street 1:8288 TELEGRAPH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1130
Mailing Address - Country:US
Mailing Address - Phone:410-695-6045
Mailing Address - Fax:
Practice Address - Street 1:8288 TELEGRAPH RD
Practice Address - Street 2:SUITE A
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1130
Practice Address - Country:US
Practice Address - Phone:410-695-6045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03598111NS0005X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty