Healthcare Provider Details

I. General information

NPI: 1780852574
Provider Name (Legal Business Name): MICHELLE LEACH CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9474 KEARNY VILLA ROAD #113
SAN DIEGO CA
92126
US

IV. Provider business mailing address

9474 KEARNY VILLA ROAD #113
SAN DIEGO CA
92126
US

V. Phone/Fax

Practice location:
  • Phone: 858-578-2070
  • Fax: 858-578-2722
Mailing address:
  • Phone: 858-578-2070
  • Fax: 858-578-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC272540
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 11426
License Number StateCA

VIII. Authorized Official

Name: DR. MICHELLE L LEACH
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 858-578-2070