Healthcare Provider Details

I. General information

NPI: 1659367308
Provider Name (Legal Business Name): ARLEN JAY LIEBERMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5685 DULUTH ST
GOLDEN VALLEY MN
55422-4054
US

IV. Provider business mailing address

5801 DULUTH ST STE 150
GOLDEN VALLEY MN
55422-3952
US

V. Phone/Fax

Practice location:
  • Phone: 763-541-1280
  • Fax: 763-541-1012
Mailing address:
  • Phone: 763-541-1280
  • Fax: 763-541-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001754
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: