Provider Demographics
NPI:1265735716
Name:LIVERMORE PERFORMANCE CHIROPRACTIC INC
Entity type:Organization
Organization Name:LIVERMORE PERFORMANCE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIVERMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-853-3797
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty