Provider Demographics
NPI:1508814724
Name:LIVINGSTON, HOWARD MONROE JR
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MONROE
Last Name:LIVINGSTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2668
Mailing Address - Country:US
Mailing Address - Phone:910-738-1253
Mailing Address - Fax:910-671-8514
Practice Address - Street 1:4145 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2668
Practice Address - Country:US
Practice Address - Phone:910-738-1253
Practice Address - Fax:910-671-8514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908597Medicaid
NC08597OtherBC/BS
NC08597OtherBC/BS
NC2446822Medicare ID - Type UnspecifiedMEDICARE