Healthcare Provider Details

I. General information

NPI: 1528090313
Provider Name (Legal Business Name): WILBERT T LIWANAG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 GRAND AVE SUITE A
GRAND JUNCTION CO
81501-2261
US

IV. Provider business mailing address

145 GRAND AVE SUITE A
GRAND JUNCTION CO
81501-2261
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-6366
  • Fax: 970-245-5619
Mailing address:
  • Phone: 970-241-6366
  • Fax: 970-245-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5656
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: