1285792176 NPI number — LIBERTY CHIROPRACTIC P.C.

Table of content: (NPI 1285792176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285792176 NPI number — LIBERTY CHIROPRACTIC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY CHIROPRACTIC P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285792176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
804 E MAIN ST
Provider Second Line Business Mailing Address:
STE A2
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24523-2919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-587-0200
Provider Business Mailing Address Fax Number:
540-587-0935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804 E MAIN ST
Provider Second Line Business Practice Location Address:
STE A2
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24523-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-587-0200
Provider Business Practice Location Address Fax Number:
540-587-0935
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EARSING
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-587-0200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104555903 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14149312 . This is a "WAUSAU" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 650305 . This is a "ACN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SSN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7005206 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 244963 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5727348002 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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