| Live Young Chiropractic | |
|
1680 Sw Saint Lucie West Blvd Ste 204 Port St Lucie FL 34986-1927 | |
| (772) 212-1111 | |
| (772) 212-0201 |
| Full Name | Live Young Chiropractic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1680 Sw Saint Lucie West Blvd Ste 204, Port St Lucie, Florida |
| Authorized Official Name and Position | Timothy M Kennedy (OWNER) |
| Authorized Official Contact | 7722121111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Young Chiropractic 318 Se Fisk Rd Port St Lucie FL 34984-8920 Ph: (860) 883-5850 | Live Young Chiropractic 1680 Sw Saint Lucie West Blvd Ste 204 Port St Lucie FL 34986-1927 Ph: (772) 212-1111 |
| NPI Number | 1073962114 |
|---|---|
| Provider Enumeration Date | 06/09/2016 |
| Last Update Date | 02/12/2019 |
| Medicare PECOS PAC ID | 1456633197 |
|---|---|
| Medicare Enrollment ID | O20170112003218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073962114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | CH11346 (Florida) | Primary |
| Provider Name | Timothy Kennedy |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1750787586 PECOS PAC ID: 1355623091 Enrollment ID: I20170112003311 |
| Provider Name | Joseph Szybinski |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1962777854 PECOS PAC ID: 7618304718 Enrollment ID: I20200303000396 |
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