Provider Demographics
NPI:1710255674
Name:LIBERTY HEALTH
Entity Type:Organization
Organization Name:LIBERTY HEALTH
Other - Org Name:HEALTHCARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-339-2460
Mailing Address - Street 1:PO BOX 1305
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-1305
Mailing Address - Country:US
Mailing Address - Phone:817-907-1009
Mailing Address - Fax:
Practice Address - Street 1:4373 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1058
Practice Address - Country:US
Practice Address - Phone:214-339-2460
Practice Address - Fax:214-339-2387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHCARE CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty