MEDICARE: LEATH CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1245959303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEATH CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	6537 N COSBY AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2380
Country	:	US
Telephone Number	:	816-587-7711
Fax Number	:

Provider Business Practice Location Address
First Line	:	6537 N COSBY AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2380
Country	:	US
Telephone Number	:	816-587-7711
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JARED LEATH
Credential	:	DC
Telephone Number	:	901-596-0361

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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Directions to “LEATH CHIROPRACTIC, LLC ” Practice Location

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