Provider Demographics
NPI:1285220152
Name:LIVWEL, RUSSELL DOC (AADP)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DOC
Last Name:LIVWEL
Suffix:
Gender:M
Credentials:AADP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW 1ST AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1711
Mailing Address - Country:US
Mailing Address - Phone:561-672-5168
Mailing Address - Fax:
Practice Address - Street 1:1801 NW 1ST AVE STE B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1711
Practice Address - Country:US
Practice Address - Phone:561-672-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath