Healthcare Provider Details

I. General information

NPI: 1104265131
Provider Name (Legal Business Name): JOSHUA PAUL LEACH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 PINE ST
MOUNT SHASTA CA
96067-2137
US

IV. Provider business mailing address

116 W MINNESOTA AVE
MCCLOUD CA
96057
US

V. Phone/Fax

Practice location:
  • Phone: 530-926-4528
  • Fax: 530-926-5070
Mailing address:
  • Phone: 530-964-2389
  • Fax: 530-964-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: