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General NPI Number Information
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NPI Number | 1033490693
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Entity Type | Organization
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Legal Business Name | BART W LEAVENS PC
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 326 3RD AVE S
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City | CLINTON
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State | IA
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Zip | 52732-4436
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Country | US
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Telephone | 536-241-4295
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Fax |
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Provider Business Mailing Address
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Address Line | 326 3RD AVE S
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City | CLINTON
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State | IA
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Zip | 52732-4436
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Country | US
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Telephone | 536-241-4295
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BART WILLIAM LEAVENS
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Credential | D.C.
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Telephone | 563-241-4295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 254254
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License Number State | IA
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