Provider Demographics
NPI:1013299676
Name:LIVERGOOD, JOSEPH A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:LIVERGOOD
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 1:730 BAYOU PINES EAST DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7494
Mailing Address - Country:US
Mailing Address - Phone:337-433-7551
Mailing Address - Fax:
Practice Address - Street 1:730 BAYOU PINES EAST DR STE A
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7494
Practice Address - Country:US
Practice Address - Phone:337-433-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor