Healthcare Provider Details

I. General information

NPI: 1699989947
Provider Name (Legal Business Name): DR JESSE LIEBMAN CHIROPRACTIC PHYSICIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLD MARLTON PIKE W
MARLTON NJ
08053-2026
US

IV. Provider business mailing address

100 OLD MARLTON PIKE W
MARLTON NJ
08053-2026
US

V. Phone/Fax

Practice location:
  • Phone: 856-596-3000
  • Fax: 856-596-7311
Mailing address:
  • Phone: 856-596-3000
  • Fax: 856-596-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number38MC00423400
License Number StateNJ

VIII. Authorized Official

Name: DR. JESSE R. LIEBMAN
Title or Position: PHYSICIAN
Credential: D.C.
Phone: 856-596-3000