Healthcare Provider Details

I. General information

NPI: 1255417986
Provider Name (Legal Business Name): RICHARD M LIBERATI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 REISTERSTOWN RD SUITE 205A
BALTIMORE MD
21215-2686
US

IV. Provider business mailing address

PO BOX 30160
BALTIMORE MD
21270-0160
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-2298
  • Fax: 410-345-8655
Mailing address:
  • Phone: 410-486-2298
  • Fax: 410-358-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01495
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number01495
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: