Healthcare Provider Details

I. General information

NPI: 1932372281
Provider Name (Legal Business Name): BRIAN M LEBARON D.C., MSA., LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BISHOP HOLLOW RD
NEWTOWN SQUARE PA
19073-3212
US

IV. Provider business mailing address

PO BOX 461
WAYNE PA
19087-0461
US

V. Phone/Fax

Practice location:
  • Phone: 619-356-2341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK000958
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009941
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: