Provider Demographics
NPI:1356464960
Name:LIBERTY CHIROPRACTIC HEALTHE & WELLNESS, P. C.
Entity Type:Organization
Organization Name:LIBERTY CHIROPRACTIC HEALTHE & WELLNESS, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:RIAD
Authorized Official - Last Name:KAYUME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-843-9827
Mailing Address - Street 1:13313 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2305
Mailing Address - Country:US
Mailing Address - Phone:718-843-9827
Mailing Address - Fax:718-843-6205
Practice Address - Street 1:13313 103RD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2305
Practice Address - Country:US
Practice Address - Phone:718-843-9827
Practice Address - Fax:718-843-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty