Provider Demographics
NPI:1699989947
Name:DR JESSE LIEBMAN CHIROPRACTIC PHYSICIAN LLC
Entity type:Organization
Organization Name:DR JESSE LIEBMAN CHIROPRACTIC PHYSICIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIEBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-596-3000
Mailing Address - Street 1:100 OLD MARLTON PIKE W
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2026
Mailing Address - Country:US
Mailing Address - Phone:856-596-3000
Mailing Address - Fax:856-596-7311
Practice Address - Street 1:100 OLD MARLTON PIKE W
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2026
Practice Address - Country:US
Practice Address - Phone:856-596-3000
Practice Address - Fax:856-596-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00423400111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU35059Medicaid
NJ2116578000OtherAMERIHEALTH
NJ2116578000OtherKEYSTONE HEALTH PLAN EAST
NJ2116578000OtherPA.BLUE SHIELD-PERSCHOICE
NJ2664713OtherAETNA
NJP2705755OtherOXFORD
NJ2116578000OtherPA.BLUE SHIELD-PERSCHOICE
NJU35059Medicaid