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General NPI Number Information
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NPI Number | 1407258551
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Entity Type | Organization
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Legal Business Name | BEYOND INNOVATION CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 12398 FM 423 SUITE 300
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City | FRISCO
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State | TX
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Zip | 75033-4758
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Country | US
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Telephone | 615-856-5542
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Fax |
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Provider Business Mailing Address
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Address Line | 12398 FM 423 SUITE 300
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City | FRISCO
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State | TX
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Zip | 75033-4758
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. MARK SHERWOOD LIEBICH
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Credential | D.C.
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Telephone | 615-856-5542
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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 | 12633
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License Number State | TX
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