Healthcare Provider Details

I. General information

NPI: 1316040777
Provider Name (Legal Business Name): MICHAEL J LIBERTI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKWAY SUITE 201
BETHEL ME
04217-4449
US

IV. Provider business mailing address

P.O. BOX 996 1 PARKWAY SUITE 201
BETHEL ME
04217
US

V. Phone/Fax

Practice location:
  • Phone: 207-824-3899
  • Fax: 207-824-7677
Mailing address:
  • Phone: 207-824-3899
  • Fax: 207-824-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number761
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR1055
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: