Provider Demographics
NPI:1437284726
Name:LIDDY, JOHN ALEC (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEC
Last Name:LIDDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23355 CALIFA ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3110
Mailing Address - Country:US
Mailing Address - Phone:310-659-1959
Mailing Address - Fax:
Practice Address - Street 1:371 N LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1924
Practice Address - Country:US
Practice Address - Phone:310-659-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16468111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18342Medicare UPIN