Provider Demographics
NPI:1104970482
Name:LIBOIRON, TABITHA WEBER (DC)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:WEBER
Last Name:LIBOIRON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:ELIZABETH
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1221 BARTON HILLS DR APT 225
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1963
Mailing Address - Country:US
Mailing Address - Phone:512-326-2301
Mailing Address - Fax:
Practice Address - Street 1:2201 DOUBLE CREEK DR STE 1001
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3836
Practice Address - Country:US
Practice Address - Phone:512-733-8838
Practice Address - Fax:512-733-8828
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10505111N00000X
MI2301009273111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV06628Medicare UPIN