Provider Demographics
NPI:1255324463
Name:LIVANOS, JEANENE (DC)
Entity Type:Individual
Prefix:MRS
First Name:JEANENE
Middle Name:
Last Name:LIVANOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JEANENE
Other - Middle Name:
Other - Last Name:NATHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:27W281 GENEVA RD, SUITE C
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190
Mailing Address - Country:US
Mailing Address - Phone:331-806-3072
Mailing Address - Fax:331-806-3073
Practice Address - Street 1:27W281 GENEVA RD, SUITE C
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:331-806-3072
Practice Address - Fax:331-806-3073
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK07948Medicare UPIN
IL209420Medicare ID - Type Unspecified