MEDICARE: DR. CHRISTOPHER LEATHERMAN 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	0104834	KS
2	111N00000X	Chiropractor	2002020065	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-4236321	OTHER		FEIN - INDIVIDUAL
2	33086038	OTHER	MO	BCBS
3	26-0522906	OTHER		FEIN - GROUP

General Provider Information

NPI Number	:	1689611964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER LEATHERMAN D.C.

Provider Business Mailing Address
First Line	:	412 AMES ST
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-3099
Country	:	US
Telephone Number	:	785-594-4894
Fax Number	:	785-594-2597

Provider Business Practice Location Address
First Line	:	412 AMES ST
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-3099
Country	:	US
Telephone Number	:	785-594-4894
Fax Number	:	785-594-2597

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	04/07/2023

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