Provider Demographics
NPI:1124067426
Name:IBERER, MICHAEL CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:IBERER
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 1:170 CHANGEBRIDGE RD
Mailing Address - Street 2:UNIT B-1
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9115
Mailing Address - Country:US
Mailing Address - Phone:973-575-1950
Mailing Address - Fax:973-575-0730
Practice Address - Street 1:170 CHANGEBRIDGE RD
Practice Address - Street 2:UNIT B-1
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9115
Practice Address - Country:US
Practice Address - Phone:973-575-1950
Practice Address - Fax:973-575-0730
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00223000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ107614OtherUNITED HEALTHCARE
NJ33029OtherMASTERCARE
NJ1031766OtherAMERICAN SPECIALTY
NJ661788OtherACN GROUP
NJ1830007Medicaid
NJ4477196OtherAETNA TRADITIONAL
NJ2425463000OtherAMERIHEALTH
NJ799859OtherAETNA HMO
NJP1224768OtherOXFORD HEALTH
NJ1830007Medicaid