=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164888277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEVINGSTON ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2016
-----------------------------------------------------
Last Update Date | 01/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 E HIGHWAY 67 STE 224
-----------------------------------------------------
City | DUNCANVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75137-4476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-587-9614
-----------------------------------------------------
Fax | 214-941-1880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 2971
-----------------------------------------------------
City | CEDAR HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-587-9614
-----------------------------------------------------
Fax | 214-941-1880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. COURTNEY LEVINGSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-314-4790
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 13079
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 102861
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------