Krystle E Lieberman Wall, DC, RD, LD, CBS LC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5317 Issued in MN

Practice address

5801 Duluth St
Suite 150
Golden Valley, MN 55422-3958

Phone

(736) 541-1280

Fax

(763) 541-1012

NPI assigned

May 10, 2010

Last updated

Sep 8, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Dr. Krystle E Lieberman Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Medical of Twin Cities, P.C.Group PAC ID 9436137643, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Medical of Twin Cities, P.C.

  • Multi-Specialty Clinic/Center
  • Golden Valley, MN
  • NPI 1952587156
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1699093021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5801 DULUTH ST",
            "address_2": "SUITE 150",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554223958",
            "telephone_number": "736-541-1280",
            "fax_number": "763-541-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 DULUTH ST",
            "address_2": "SUITE 150",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554223958",
            "telephone_number": "736-541-1280",
            "fax_number": "763-541-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "KRYSTLE",
        "middle_name": "E LIEBERMAN",
        "name_prefix": "Dr.",
        "credential": "DC, RD, LD, CBS LC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-10",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5317",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "2716",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "MN",
            "license": "876",
            "primary": false
        },
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "MN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTLE",
            "last_name": "LIEBERMAN",
            "middle_name": "E",
            "prefix": "DR.",
            "credential": "DC, RD, LD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Chiropractor in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.