Provider Demographics
NPI:1912309113
Name:LIEBICH, MARK SHERWOOD (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:SHERWOOD
Last Name:LIEBICH
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 1:12398 FM 423 STE 300
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-0154
Mailing Address - Country:US
Mailing Address - Phone:615-856-5542
Mailing Address - Fax:
Practice Address - Street 1:12398 FM 423 STE 300
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-0154
Practice Address - Country:US
Practice Address - Phone:615-856-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor