Healthcare Provider Details

I. General information

NPI: 1952325433
Provider Name (Legal Business Name): MABLE MARIE LECKRONE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W MILL ST
LIBERTY MO
64068-2339
US

IV. Provider business mailing address

401 SMILEY RD
LIBERTY MO
64068-7705
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-8810
  • Fax: 816-781-3468
Mailing address:
  • Phone: 816-781-8810
  • Fax: 816-781-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number003838
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: