Provider Demographics
NPI:1427198498
Name:LIBERTY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LIBERTY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-427-0008
Mailing Address - Street 1:P.O. BOX 3393
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02304
Mailing Address - Country:US
Mailing Address - Phone:508-427-0008
Mailing Address - Fax:
Practice Address - Street 1:953 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6681
Practice Address - Country:US
Practice Address - Phone:508-427-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACO Y45717Medicare ID - Type Unspecified