Healthcare Provider Details

I. General information

NPI: 1881062487
Provider Name (Legal Business Name): LIV INTEGRATIVE HEATH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20301 SW ACACIA ST 250
NEWPORT BEACH CA
92660-1732
US

IV. Provider business mailing address

20301 SW ACACIA ST 250
NEWPORT BEACH CA
92660-1732
US

V. Phone/Fax

Practice location:
  • Phone: 949-274-7104
  • Fax: 949-274-7644
Mailing address:
  • Phone: 949-274-7104
  • Fax: 949-274-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number31926
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number31926
License Number StateCA

VIII. Authorized Official

Name: DR. DANIELLE BEVIER
Title or Position: DOCTOR OF CHIROPRACTIC/ CEO
Credential: DC
Phone: 949-274-7104