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General NPI Number Information
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NPI Number | 1104448547
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Entity Type | Individual
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Provider Name | KATIE NIEBUR ND, DC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 115 W MAPLE AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2119
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Country | US
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Telephone | 708-362-2337
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Fax |
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Provider Business Mailing Address
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Address Line | 11454 193RD ST
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City | MOKENA
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State | IL
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Zip | 60448-8423
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Country | US
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Telephone | 708-362-2337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 038103439
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.013439
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License Number State | IL
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