=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518158658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGER CHIROREHAB LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2007
-----------------------------------------------------
Last Update Date | 07/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 BASE LINE RD
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60538-1237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-906-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 BASELINE RD
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60538-1237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-906-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DAVID D LEGER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 630-906-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number | 038-005668
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------