MEDICARE: LEONARD J LECLAIR DC

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
1	111NS0005X	Sports Physician Chiropractor	2301005142	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154382984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD J LECLAIR DC

Provider Business Mailing Address
First Line	:	806 W CEDAR ST
Second Line	:
City	:	STANDISH
State	:	MI
Zip	:	48658-9550
Country	:	US
Telephone Number	:	989-846-4660
Fax Number	:	989-846-4668

Provider Business Practice Location Address
First Line	:	806 W CEDAR ST
Second Line	:
City	:	STANDISH
State	:	MI
Zip	:	48658-9550
Country	:	US
Telephone Number	:	989-846-4660
Fax Number	:	989-846-4668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/25/2008

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