Provider Demographics
NPI:1609843796
Name:LIEBMAN, NEIL K (DC,CCST)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:K
Last Name:LIEBMAN
Suffix:
Gender:M
Credentials:DC,CCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 BROWNING RD
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-1910
Mailing Address - Country:US
Mailing Address - Phone:856-662-4455
Mailing Address - Fax:856-662-5600
Practice Address - Street 1:2123 BROWNING RD
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1910
Practice Address - Country:US
Practice Address - Phone:856-662-4455
Practice Address - Fax:856-662-5600
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00341200111N00000X
PADC003513L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6097103Medicaid
PA0085994000OtherKEYSTONE
PA0085994000OtherAMERIHEALTH
GA6484723OtherCIGNA
TX5198122OtherAETNA
VA22308OtherAMERIGROUP
GA878808OtherUNITED HEALTHCARE
CA1K0042OtherLANDMARK
CA1K0042OtherLANDMARK