Healthcare Provider Details

I. General information

NPI: 1154382984
Provider Name (Legal Business Name): LEONARD J LECLAIR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 W CEDAR ST
STANDISH MI
48658-9550
US

IV. Provider business mailing address

806 W CEDAR ST
STANDISH MI
48658-9550
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-4660
  • Fax: 989-846-4668
Mailing address:
  • Phone: 989-846-4660
  • Fax: 989-846-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2301005142
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: