Provider Demographics
NPI:1003405887
Name:LIVINGSTON, CHASE WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:WILLIAM
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHASE
Other - Middle Name:WILLIAM
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:159 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1605
Mailing Address - Country:US
Mailing Address - Phone:860-374-2802
Mailing Address - Fax:860-271-8115
Practice Address - Street 1:159 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1605
Practice Address - Country:US
Practice Address - Phone:860-374-2802
Practice Address - Fax:860-271-8115
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor