Provider Demographics
NPI:1578728028
Name:LIBERTY CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:LIBERTY CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUGLIOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-907-8501
Mailing Address - Street 1:1135 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-2060
Mailing Address - Country:US
Mailing Address - Phone:630-907-8501
Mailing Address - Fax:630-907-8502
Practice Address - Street 1:1135 OAK ST
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-2060
Practice Address - Country:US
Practice Address - Phone:630-907-8501
Practice Address - Fax:630-907-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty