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NPI Code Detail

MEDICARE: LEACH CHIROPRACTIC LLC

MEDICARE: LEACH CHIROPRACTIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor

General Provider Information

NPI Number : 1063120178
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEACH CHIROPRACTIC LLC
Provider Business Mailing Address
First Line : 838 W DRAKE RD STE 105
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-5539
Country : US
Telephone Number : 970-294-4197
Fax Number : 970-294-4186
Provider Business Practice Location Address
First Line : 838 W DRAKE RD STE 105
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-5539
Country : US
Telephone Number : 970-294-4197
Fax Number : 970-294-4186
Authorized Official
Title or Position : OWNER OF THE ENTITY
Name : TODD A LEACH
Credential :
Telephone Number : 970-294-4197
Provider Enumeration Date : 11/08/2022
Last Update Date : 11/08/2022

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Directions to “LEACH CHIROPRACTIC LLC ” Practice Location

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