Provider Demographics
NPI:1497523492
Name:100 CHIROPRACTIC LGOOD FOL INC
Entity Type:Organization
Organization Name:100 CHIROPRACTIC LGOOD FOL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-244-5142
Mailing Address - Street 1:20551 N PIMA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25005 BLUE RAVINE RD STE 130
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-5706
Practice Address - Country:US
Practice Address - Phone:916-932-4838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty