Provider Demographics
NPI:1316040777
Name:LIBERTI, MICHAEL J (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:LIBERTI
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:P.O. BOX 996
Mailing Address - Street 2:1 PARKWAY SUITE 201
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217
Mailing Address - Country:US
Mailing Address - Phone:207-824-3899
Mailing Address - Fax:207-824-7677
Practice Address - Street 1:1 PARKWAY SUITE 201
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217-4449
Practice Address - Country:US
Practice Address - Phone:207-824-3899
Practice Address - Fax:207-824-7677
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA761111N00000X
MECR1055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131690099Medicaid
ME043438OtherANTHEM BCBS
10903077OtherCAQH
10903077OtherCAQH
MEE800313397Medicare PIN