Provider Demographics
NPI:1689901779
Name:LIVERMORE, THOMAS A (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:LIVERMORE
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 1:612 W LAKE LANSING RD
Mailing Address - Street 2:STE 300
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8528
Mailing Address - Country:US
Mailing Address - Phone:517-853-3797
Mailing Address - Fax:517-336-7737
Practice Address - Street 1:612 W LAKE LANSING RD
Practice Address - Street 2:STE 300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8528
Practice Address - Country:US
Practice Address - Phone:517-853-3797
Practice Address - Fax:517-336-7737
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210381Medicare UPIN