Provider Demographics
NPI:1295892420
Name:LIEURANCE, CHERYL ANN (DC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:LIEURANCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:CASSOPOLIS
Mailing Address - State:MI
Mailing Address - Zip Code:49031-0173
Mailing Address - Country:US
Mailing Address - Phone:269-445-2249
Mailing Address - Fax:269-445-8294
Practice Address - Street 1:412 E STATE ST
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-1330
Practice Address - Country:US
Practice Address - Phone:264-445-2249
Practice Address - Fax:269-445-8294
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A450190OtherBLUE CROSS I.D.#
MI13489Medicare UPIN
MI0A45019Medicare ID - Type UnspecifiedI.D. #