Provider Demographics
NPI:1487749073
Name:CHUCK LIVINGSTON PA PLLC
Entity type:Organization
Organization Name:CHUCK LIVINGSTON PA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:585-243-7620
Mailing Address - Street 1:61 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454
Mailing Address - Country:US
Mailing Address - Phone:585-243-7620
Mailing Address - Fax:585-243-1132
Practice Address - Street 1:61 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-243-7620
Practice Address - Fax:585-243-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty