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General NPI Number Information
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NPI Number | 1043830946
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Entity Type | Organization
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Legal Business Name | LEACH CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 214 RUSSELL ST
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City | STARKVILLE
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State | MS
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Zip | 39759-3381
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Country | US
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Telephone | 662-323-2371
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Fax | 662-323-2382
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Provider Business Mailing Address
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Address Line | PO BOX 80121
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City | STARKVILLE
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State | MS
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Zip | 39759-0121
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Country | US
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Telephone | 662-323-2371
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Fax | 662-323-2382
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. ROBERT A LEACH
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Credential | DC
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Telephone | 662-352-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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