Provider Demographics
NPI:1316521065
Name:100 PERCENT CHIROPRACTIC LIVINGOOD, INC
Entity type:Organization
Organization Name:100 PERCENT CHIROPRACTIC LIVINGOOD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONBOARDING
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-217-0895
Mailing Address - Street 1:18025 CALLE AMBIENTE STE 204
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-9549
Mailing Address - Country:US
Mailing Address - Phone:719-271-0895
Mailing Address - Fax:
Practice Address - Street 1:129-131 W. CALIFORNIA BLVD.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:266-529-3153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty