Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 33042 | CA |
N | 111NN1001X | Nutrition | 33042 | CA |
N | 111NP0017X | Pediatric Chiropractor | 33042 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | 33042 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 33042 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 33042 | CA |
NPI | 1669848180 |
---|---|
Provider Name | Dr. Jennifer Liebersbach |
First Address | Mammoth Lakes, CA 93546-0505 |
Second Address | Mammoth Lakes, CA 93546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2015 |
Last Update Date | 19/08/2015 |