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General NPI Number Information
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NPI Number | 1124067426
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Entity Type | Individual
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Provider Name | MICHAEL CHARLES IBERER D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 170 CHANGEBRIDGE RD UNIT B-1
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City | MONTVILLE
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State | NJ
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Zip | 07045-9115
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Country | US
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Telephone | 973-575-1950
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Fax | 973-575-0730
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Provider Business Mailing Address
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Address Line | 170 CHANGEBRIDGE RD UNIT B-1
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City | MONTVILLE
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State | NJ
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Zip | 07045-9115
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Country | US
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Telephone | 973-575-1950
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Fax | 973-575-0730
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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 | 38MC00223000
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License Number State | NJ
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