Provider Demographics
NPI:1356494413
Name:LIVINGSTON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LIVINGSTON CHIROPRACTIC LLC
Other - Org Name:UNITED CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-774-2998
Mailing Address - Street 1:16095 PROSPERITY DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4259
Mailing Address - Country:US
Mailing Address - Phone:317-774-2998
Mailing Address - Fax:317-774-3130
Practice Address - Street 1:16095 PROSPERITY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4259
Practice Address - Country:US
Practice Address - Phone:317-774-2998
Practice Address - Fax:317-774-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002173A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000391156OtherANTHEM
IN000000391156OtherANTHEM
INV07246Medicare UPIN