Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2212 | CT |
NPI | 1003405887 |
---|---|
Provider Name | Chase William Livingston |
First Address | Mystic, CT 06355-1938 |
Second Address | Mystic, CT 06355-1938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2021 |
Last Update Date | 15/01/2021 |