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General NPI Number Information
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NPI Number | 1063874246
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Entity Type | Organization
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Legal Business Name | LIESKE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 1217 WHITE ST
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City | KEY WEST
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State | FL
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Zip | 33040-3367
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Country | US
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Telephone | 305-292-7222
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Fax | 888-473-3112
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Provider Business Mailing Address
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Address Line | 1217 WHITE ST
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City | KEY WEST
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State | FL
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Zip | 33040-3367
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Country | US
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Telephone | 305-292-7222
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Fax | 888-473-3112
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE HARLEN LIESKE
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Credential | DC
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Telephone | 305-292-7222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH11536
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License Number State | FL
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