Provider Demographics
NPI:1528090313
Name:LIWANAG, WILBERT T (DC)
Entity type:Individual
Prefix:DR
First Name:WILBERT
Middle Name:T
Last Name:LIWANAG
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 1:145 GRAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2261
Mailing Address - Country:US
Mailing Address - Phone:970-241-6366
Mailing Address - Fax:970-245-5619
Practice Address - Street 1:145 GRAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2261
Practice Address - Country:US
Practice Address - Phone:970-241-6366
Practice Address - Fax:970-245-5619
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor