Provider Demographics
NPI:1396996153
Name:LIEBERT, THOR M (ND)
Entity type:Individual
Prefix:DR
First Name:THOR
Middle Name:M
Last Name:LIEBERT
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S 1ST ST
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3532
Mailing Address - Country:US
Mailing Address - Phone:406-375-1771
Mailing Address - Fax:
Practice Address - Street 1:225 S 1ST ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3532
Practice Address - Country:US
Practice Address - Phone:406-375-1771
Practice Address - Fax:406-375-0990
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine