Provider Demographics
NPI:1073896932
Name:LIVINGSTON CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:LIVINGSTON CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:440-528-0005
Mailing Address - Street 1:25111 MILES RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5482
Mailing Address - Country:US
Mailing Address - Phone:440-528-0005
Mailing Address - Fax:440-528-0011
Practice Address - Street 1:25111 MILES RD
Practice Address - Street 2:SUITE D
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5482
Practice Address - Country:US
Practice Address - Phone:440-528-0005
Practice Address - Fax:440-528-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103435Medicaid
OHLI0774452Medicare PIN