Provider Demographics
NPI:1659367308
Name:LIEBERMAN, ARLEN JAY (DC)
Entity Type:Individual
Prefix:
First Name:ARLEN
Middle Name:JAY
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 DULUTH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3952
Mailing Address - Country:US
Mailing Address - Phone:763-541-1280
Mailing Address - Fax:763-541-1012
Practice Address - Street 1:5685 DULUTH ST
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4054
Practice Address - Country:US
Practice Address - Phone:763-541-1280
Practice Address - Fax:763-541-1012
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN754727700Medicaid
MN09841LIOtherBCBS
MN754727700Medicaid