Provider Demographics
NPI:1669695540
Name:LIBERMAN, MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 SUNSET OFFICE DR STE C102
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1014
Mailing Address - Country:US
Mailing Address - Phone:314-858-1858
Mailing Address - Fax:314-261-9184
Practice Address - Street 1:3555 SUNSET OFFICE DR STE C102
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1014
Practice Address - Country:US
Practice Address - Phone:314-858-1858
Practice Address - Fax:314-261-9184
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor