Provider Demographics
NPI:1942076807
Name:LIBERTY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LIBERTY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-980-0614
Mailing Address - Street 1:1421 N MEADOWWOOD LN STE 80
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-6021
Mailing Address - Country:US
Mailing Address - Phone:360-980-0614
Mailing Address - Fax:
Practice Address - Street 1:1421 N MEADOWWOOD LN STE 80
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6021
Practice Address - Country:US
Practice Address - Phone:360-980-0614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty