Provider Demographics
NPI:1265647374
Name:LIEDBERG, MARK CHRISTIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTIAN
Last Name:LIEDBERG
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:PO BOX 799
Mailing Address - Street 2:HIGHWAY 136 WEST
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-0799
Mailing Address - Country:US
Mailing Address - Phone:706-657-7581
Mailing Address - Fax:706-657-2080
Practice Address - Street 1:4467 HIGHWAY 136 WEST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-0799
Practice Address - Country:US
Practice Address - Phone:706-657-7581
Practice Address - Fax:706-657-2080
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO002739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor