Provider Demographics
NPI:1659081594
Name:LIBERTY CHIROPRACTIC INSTITUTE PLLC
Entity Type:Organization
Organization Name:LIBERTY CHIROPRACTIC INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HAMLIN
Authorized Official - Last Name:PERSONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-708-3648
Mailing Address - Street 1:5500 MCNEELY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7623
Mailing Address - Country:US
Mailing Address - Phone:757-708-3648
Mailing Address - Fax:
Practice Address - Street 1:5500 MCNEELY DR STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7623
Practice Address - Country:US
Practice Address - Phone:757-708-3648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty