=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932209285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS P. LIBENGOOD D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 04/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 OHIO PIKE SUITE 121-F
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-947-9355
-----------------------------------------------------
Fax | 513-947-0190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 OHIO PIKE SUITE 121-F
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-947-9355
-----------------------------------------------------
Fax | 513-947-0190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2252
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------