=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457539827
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD DAVID LIESER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2008
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1946 S TAMIAMI TRL
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34293-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-977-2871
-----------------------------------------------------
Fax | 941-977-2871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1946 S TAMIAMI TRL
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34293-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-977-2871
-----------------------------------------------------
Fax | 941-977-2871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH12450
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------