MEDICARE: MR. MICHAEL J LIBERTI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	761	MA
2	111N00000X	Chiropractor	CR1055	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	043438	OTHER	ME	ANTHEM BCBS
3	10903077	OTHER		CAQH

General Provider Information

NPI Number	:	1316040777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL J LIBERTI DC

Provider Business Mailing Address
First Line	:	P.O. BOX 996
Second Line	:	1 PARKWAY SUITE 201
City	:	BETHEL
State	:	ME
Zip	:	04217
Country	:	US
Telephone Number	:	207-824-3899
Fax Number	:	207-824-7677

Provider Business Practice Location Address
First Line	:	1 PARKWAY SUITE 201
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-4449
Country	:	US
Telephone Number	:	207-824-3899
Fax Number	:	207-824-7677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	08/18/2022

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Directions to “ MR. MICHAEL J LIBERTI DC” Practice Location

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