MEDICARE: DR. JOHN ALEC LIDDY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	DC16468	CA

General Provider Information

NPI Number	:	1437284726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALEC LIDDY DC

Provider Business Mailing Address
First Line	:	23355 CALIFA ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3110
Country	:	US
Telephone Number	:	310-659-1959
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 N LA CIENEGA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1924
Country	:	US
Telephone Number	:	310-659-1959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	04/24/2015

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