Provider Demographics
NPI:1245485887
Name:LIBERAL FAMILY CHIROPRACTIC INC
Entity type:Organization
Organization Name:LIBERAL FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
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 1:2330 N. KANSAS AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901
Mailing Address - Country:US
Mailing Address - Phone:620-624-7773
Mailing Address - Fax:620-626-7396
Practice Address - Street 1:2330 N KANSAS AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2372
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:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
660035OtherBCBS
062047OtherMEDICARE ID
062047OtherMEDICARE ID