=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407105554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEIGH DAMKOHLER, DC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2012
-----------------------------------------------------
Last Update Date | 09/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 BACON PL
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10710-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-523-7947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 BACON PL
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10710-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LEIGH DAMKOHLER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 914-523-7947
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | X010907
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------