Healthcare Provider Details

I. General information

NPI: 1942254982
Provider Name (Legal Business Name): MICHAEL F LIDDELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 RAY LAWYER DR SUITE 102
PLACERVILLE CA
95667-3934
US

IV. Provider business mailing address

2864 RAY LAWYER DR SUITE 102
PLACERVILLE CA
95667-3934
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-3440
  • Fax: 530-626-3440
Mailing address:
  • Phone: 530-626-3440
  • Fax: 530-626-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC0244770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: