Healthcare Provider Details

I. General information

NPI: 1356494413
Provider Name (Legal Business Name): LIVINGSTON CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16095 PROSPERITY DR SUITE 100
NOBLESVILLE IN
46060-4259
US

IV. Provider business mailing address

16095 PROSPERITY DR
NOBLESVILLE IN
46060-4259
US

V. Phone/Fax

Practice location:
  • Phone: 317-774-2998
  • Fax: 317-774-3130
Mailing address:
  • Phone: 317-774-2998
  • Fax: 317-774-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002173A
License Number StateIN

VIII. Authorized Official

Name: DR. CHARLES STEPHEN LIVINGSTON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 317-774-2998