Provider Demographics
NPI:1336491638
Name:LIBERTY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LIBERTY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-465-2500
Mailing Address - Street 1:128 N DETROIT ST
Mailing Address - Street 2:PO BOX 752
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-9458
Mailing Address - Country:US
Mailing Address - Phone:937-465-2500
Mailing Address - Fax:937-465-2505
Practice Address - Street 1:128 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357-9458
Practice Address - Country:US
Practice Address - Phone:937-465-2500
Practice Address - Fax:937-465-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty