Provider Demographics
NPI:1225181407
Name:LIVINGSTON COUNTY CHIROPRACTIC CENTER, LTD.
Entity Type:Organization
Organization Name:LIVINGSTON COUNTY CHIROPRACTIC CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-844-4631
Mailing Address - Street 1:1504 W REYNOLDS ST STE A
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-9786
Mailing Address - Country:US
Mailing Address - Phone:815-844-4631
Mailing Address - Fax:815-844-1942
Practice Address - Street 1:1504 W REYNOLDS ST STE A
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-9786
Practice Address - Country:US
Practice Address - Phone:815-844-4631
Practice Address - Fax:815-844-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208518Medicare ID - Type UnspecifiedMEDICARE NUMBER