Provider Demographics
NPI:1699877415
Name:LIVINGSTON, CHARLES STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STEPHEN
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8902 N MERIDIAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5382
Mailing Address - Country:US
Mailing Address - Phone:317-848-8048
Mailing Address - Fax:317-575-8807
Practice Address - Street 1:8902 N MERIDIAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5382
Practice Address - Country:US
Practice Address - Phone:317-848-8048
Practice Address - Fax:317-575-8807
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002173A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000512900OtherANTHEM BC/BS
IN828570CMedicare PIN