1225251580 NPI number — LIVINGSTON CHIROPRACTIC CLINIC, P.A.

Table of content: (NPI 1225251580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225251580 NPI number — LIVINGSTON CHIROPRACTIC CLINIC, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIVINGSTON CHIROPRACTIC CLINIC, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOT SPRINGS CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225251580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
242 HOBSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71913-3746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-623-2701
Provider Business Mailing Address Fax Number:
501-623-9105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
242 HOBSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-3746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-623-2701
Provider Business Practice Location Address Fax Number:
501-623-9105
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIVINGSTON
Authorized Official First Name:
VICKY
Authorized Official Middle Name:
ROSEANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-623-2701

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1441 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 145136718 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145137718 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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