Provider Demographics
NPI:1043392277
Name:LIVOLSI, PHILIP F (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:LIVOLSI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 E CYPRESS AVE #700
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1040
Mailing Address - Country:US
Mailing Address - Phone:530-221-0253
Mailing Address - Fax:530-229-9080
Practice Address - Street 1:926 E CYPRESS AVE #700
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1040
Practice Address - Country:US
Practice Address - Phone:530-221-0253
Practice Address - Fax:530-229-9080
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU46930Medicare ID - Type Unspecified
CADC0227760Medicare UPIN