MEDICARE: DR. NEIL K LIEBMAN DC,C.C.S.T.

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	38MC00341200	NJ
2	111N00000X	Chiropractor	DC003513L	PA

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	0085994000	OTHER	PA	KEYSTONE
3	0085994000	OTHER	PA	AMERIHEALTH
4	6484723	OTHER	GA	CIGNA
5	5198122	OTHER	TX	AETNA
6	22308	OTHER	VA	AMERIGROUP
7	878808	OTHER	GA	UNITED HEALTHCARE
8	1K0042	OTHER	CA	LANDMARK

General Provider Information

NPI Number	:	1609843796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL K LIEBMAN DC,C.C.S.T.

Provider Business Mailing Address
First Line	:	2123 BROWNING RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1910
Country	:	US
Telephone Number	:	856-662-4455
Fax Number	:	856-662-5600

Provider Business Practice Location Address
First Line	:	2123 BROWNING RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1910
Country	:	US
Telephone Number	:	856-662-4455
Fax Number	:	856-662-5600

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	09/25/2007

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