Provider Demographics
NPI:1225148661
Name:LIEBEL, RICHARD MILTON (DC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MILTON
Last Name:LIEBEL
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 1:7677 CENTER AVE
Mailing Address - Street 2:STE 403
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3074
Mailing Address - Country:US
Mailing Address - Phone:714-379-9355
Mailing Address - Fax:714-379-5402
Practice Address - Street 1:7677 CENTER AVE STE 403
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3098
Practice Address - Country:US
Practice Address - Phone:714-379-9355
Practice Address - Fax:714-379-5402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA208155724Medicare PIN