Provider Demographics
NPI:1497300065
Name:LIVINGSTON, GREG A (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:A
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 FIRCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-6010
Mailing Address - Country:US
Mailing Address - Phone:971-678-5151
Mailing Address - Fax:
Practice Address - Street 1:7642 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2437
Practice Address - Country:US
Practice Address - Phone:971-678-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC160813171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist