Healthcare Provider Details

I. General information

NPI: 1427376110
Provider Name (Legal Business Name): JULIA MARIE LIEBICH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24W788 75TH ST
NAPERVILLE IL
60565-1684
US

IV. Provider business mailing address

24W788 75TH ST
NAPERVILLE IL
60565-1684
US

V. Phone/Fax

Practice location:
  • Phone: 608-239-4700
  • Fax:
Mailing address:
  • Phone: 712-883-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: