Provider Demographics
NPI:1578774469
Name:LIBERTY WELLNESS & CHIRO PC
Entity Type:Organization
Organization Name:LIBERTY WELLNESS & CHIRO PC
Other - Org Name:LIBERTY WELLNESS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AO/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-742-8000
Mailing Address - Street 1:30 WALL ST STE 500
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2201
Mailing Address - Country:US
Mailing Address - Phone:212-742-8000
Mailing Address - Fax:212-742-1557
Practice Address - Street 1:30 WALL ST STE 500
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2201
Practice Address - Country:US
Practice Address - Phone:212-742-8000
Practice Address - Fax:212-742-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006851-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty