Healthcare Provider Details

I. General information

NPI: 1114912359
Provider Name (Legal Business Name): DONNA LIEBERMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 TOMPKINS ST
CORTLAND NY
13045-2429
US

IV. Provider business mailing address

120 TOMPKINS ST
CORTLAND NY
13045-2429
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-1884
  • Fax: 607-753-1540
Mailing address:
  • Phone: 607-753-1884
  • Fax: 607-753-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX004753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: