KRYSTLE E LIEBERMAN D.C., R.D., NPI 1699093021 — GOLDEN VALLEY (MN)

NPI 1699093021

9+ Years Experience Individual

KRYSTLE E LIEBERMAN D.C., R.D.

05.10.2010
PROVIDER ENUMERATION DATE
05.10.2010
LAST UPDATE DATE
1699093021
NPI NUMBER

About KRYSTLE E LIEBERMAN

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

KRYSTLE E LIEBERMAN is a provider established in GOLDEN VALLEY, MN. The NPI number of KRYSTLE E LIEBERMAN is 1699093021 and was assigned on 05.10.2010. The practitioners primary taxonomy code is: 111N00000X with license number: 5317 MN .

Mailing address

  • City: GOLDEN VALLEY
  • State: MN
  • Postal code: 554223958
  • Phone: 7365411280
  • Fax: 7635411012
  • Address: 5801 DULUTH ST
  • Address 2: SUITE 150

Primary Practice Address

  • Region : GOLDEN VALLEY, MN
  • NPI : 1699093021
  • Phone : 7365411280
  • Fax : 7635411012
  • Postalcode : 554223958
  • Address : 5801 DULUTH ST SUITE 150

Provider taxonomy - Chiropractor

  • Taxonomy code: 111N00000X
  • License number: 5317
  • License state: MN

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

Healthcare provider taxonomy #2 - Dietitian, Registered

  • Taxonomy code: 133V00000X
  • License number: 2716
  • License state: MN

The taxonomy is not the primary taxonomy.

Taxonomy description: A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession"s systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

Contacts:

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  • KRYSTLE E LIEBERMAN D.C., R.D.
  • Address : 5801 DULUTH ST SUITE 150
  • Region : GOLDEN VALLEY, MN
  • NPI : 1699093021
  • Phone : 7365411280
  • Fax : 7635411012
  • Postalcode : 554223958

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address5801 DULUTH ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 150
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameGOLDEN VALLEY
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMN
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code554223958
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number7365411280
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number7635411012
The fax number associated with the location address of the provider being identified.
NPI1699093021
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1111N00000X
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
Provider Enumeration Date05.10.2010
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated05.10.2010
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)KRYSTLE E LIEBERMAN
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address5801 DULUTH ST
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE 150
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameGOLDEN VALLEY
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMN
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code554223958
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number7365411280
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number7635411012
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1111N00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
Provider License Number 15317
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MN
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2133V00000X
Healthcare Provider Taxonomy 2Dietitian, Registered
A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession"s systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
Provider License Number 22716
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2MN
Healthcare Provider Primary Taxonomy Switch 2N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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