Provider Demographics
NPI:1942471784
Name:LIVOTI WALPOLE, MERCEDES MARIA (DC, MSACN)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MARIA
Last Name:LIVOTI WALPOLE
Suffix:
Gender:F
Credentials:DC, MSACN
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:MARIA
Other - Last Name:LIVOTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, MSACN
Mailing Address - Street 1:1600 SPRUCE TREE CENTRE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-209-6060
Mailing Address - Fax:651-209-6063
Practice Address - Street 1:4054 SAWYER RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1272
Practice Address - Country:US
Practice Address - Phone:651-209-6060
Practice Address - Fax:651-209-6063
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 5003111N00000X
FLCH-11553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor