Provider Demographics
NPI:1689633133
Name:LIBERAL FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:LIBERAL FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-624-7773
Mailing Address - Street 1:110 LILAC DR
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2059
Mailing Address - Country:US
Mailing Address - Phone:620-624-7773
Mailing Address - Fax:620-626-7396
Practice Address - Street 1:110 LILAC DR
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2059
Practice Address - Country:US
Practice Address - Phone:620-624-7773
Practice Address - Fax:620-626-7396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660035OtherBCBS OF KANSAS
KS660035OtherBCBS OF KANSAS
KS062047Medicare ID - Type Unspecified