MEDICARE: DR. MARCELLO S. LEAO D.C.

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	038010675	IL

General Provider Information

NPI Number	:	1447297361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCELLO S. LEAO D.C.

Provider Business Mailing Address
First Line	:	25 TELSER RD UNIT 766
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-3634
Country	:	US
Telephone Number	:	847-920-4160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 RODGERS COURT
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047
Country	:	US
Telephone Number	:	847-920-4160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/27/2019

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