Provider Demographics
NPI:1184278525
Name:LIVING ROOTS CORPORATION
Entity type:Organization
Organization Name:LIVING ROOTS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLOA-JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-296-8615
Mailing Address - Street 1:900 FULTON AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4517
Mailing Address - Country:US
Mailing Address - Phone:916-488-8307
Mailing Address - Fax:916-244-0564
Practice Address - Street 1:900 FULTON AVE STE 150
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4517
Practice Address - Country:US
Practice Address - Phone:916-488-8307
Practice Address - Fax:916-244-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty