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General NPI Number Information
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NPI Number | 1548375363
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Entity Type | Organization
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Legal Business Name | LIBERTY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1500 N WASHINGTON AVE
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City | ROSWELL
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State | NM
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Zip | 88201-3250
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Country | US
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Telephone | 505-622-8118
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Fax | 505-622-6946
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Provider Business Mailing Address
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Address Line | PO BOX 3265
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City | ROSWELL
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State | NM
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Zip | 88202-3265
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Country | US
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Telephone | 505-622-8118
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Fax | 505-622-6946
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRY TODD
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Credential | DC
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Telephone | 505-622-8118
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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 |
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License Number State |
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