Healthcare Provider Details

I. General information

NPI: 1740722511
Provider Name (Legal Business Name): LECLERE FAMILY CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E MAPLE ST
CENTRAL CITY IA
52214-7732
US

IV. Provider business mailing address

PO BOX 357
CENTRAL CITY IA
52214-0357
US

V. Phone/Fax

Practice location:
  • Phone: 319-438-1089
  • Fax: 319-438-1091
Mailing address:
  • Phone: 319-438-1089
  • Fax: 319-438-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number072766
License Number StateIA

VIII. Authorized Official

Name: DR. DANIEL ROBERT LECLERE
Title or Position: OWNER
Credential: D.C.
Phone: 319-438-1089