Provider Demographics
NPI:1669591277
Name:LIEBERMAN -GARRETT, ERICA R (DC)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:R
Last Name:LIEBERMAN -GARRETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:R
Other - Last Name:LIEBERMAN-GARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:90290 OVERSEAS HIGHWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070
Mailing Address - Country:US
Mailing Address - Phone:305-853-1003
Mailing Address - Fax:305-853-0880
Practice Address - Street 1:90290 OVERSEAS HIGHWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070
Practice Address - Country:US
Practice Address - Phone:305-853-1003
Practice Address - Fax:305-853-0880
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
55237OtherBCBS
U54798Medicare UPIN
55237Medicare ID - Type Unspecified