MEDICARE: LEIB LTD

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	0104000871	VA

General Provider Information

NPI Number	:	1710054408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEIB LTD

Provider Business Mailing Address
First Line	:	397 LITTLE NECK RD
Second Line	:	3400 BUILDING, SUITE 108
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5765
Country	:	US
Telephone Number	:	757-431-2225
Fax Number	:	757-431-9314

Provider Business Practice Location Address
First Line	:	397 LITTLE NECK RD
Second Line	:	3400 BUILDING, SUITE 108
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5765
Country	:	US
Telephone Number	:	757-431-2225
Fax Number	:	757-431-9314

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT GEORGE LEIB JR.
Credential	:	D.C.
Telephone Number	:	757-431-2225

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	02/29/2008

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Practice Fax: 757-431-9314

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