Provider Demographics
NPI:1730264367
Name:LIGERTWOOD, PAUL ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDREW
Last Name:LIGERTWOOD
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 1:10129 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-3424
Mailing Address - Country:US
Mailing Address - Phone:727-819-2273
Mailing Address - Fax:727-863-9313
Practice Address - Street 1:10129 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-3424
Practice Address - Country:US
Practice Address - Phone:727-819-2273
Practice Address - Fax:727-863-9313
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7653111N00000X
GACHIR005809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3814289-00Medicaid
FL3814289-00Medicaid