Provider Demographics
NPI:1528557287
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:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:JON
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-275-2244
Mailing Address - Street 1:5132 S CLIFF AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5132 S CLIFF AVE STE 4
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5434
Practice Address - Country:US
Practice Address - Phone:605-275-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty