Individual
DR. JOHN S LIVELY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2710 BROADWAY EXT, PARKERSBURG, WV 26101-6856
(304) 485-0106
(304) 485-5671
Mailing address
2710 BROADWAY EXT, PARKERSBURG, WV 26101-6856
(304) 485-0106
(304) 485-5671
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
632
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0132099000
—
WV
01
—
1035106
WORKERS COMP
WV
01
—
5630092
AETNA
—
Enumeration date
05/26/2006
Last updated
07/08/2007
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