Provider Demographics
NPI:1457539827
Name:LIESER, CHAD DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DAVID
Last Name:LIESER
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5001
Mailing Address - Country:US
Mailing Address - Phone:941-977-2871
Mailing Address - Fax:941-977-2871
Practice Address - Street 1:1946 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5001
Practice Address - Country:US
Practice Address - Phone:941-977-2871
Practice Address - Fax:941-977-2871
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12450111N00000X
MN4288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO510578Medicare PIN