=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568356046
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACHARY LIBBY DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2025
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 LAKE AIR DR STE 7
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76710-4452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-741-5992
-----------------------------------------------------
Fax | 866-571-1622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 LAKE AIR DR STE 7
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76710-4452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-741-5992
-----------------------------------------------------
Fax | 866-571-1622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 16390
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------