MEDICARE: LEAH S OWENS DC 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
1	261Q00000X	Clinic/Center	2013045695	MO

General Provider Information

NPI Number	:	1437571122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAH S OWENS DC LLC

Provider Business Mailing Address
First Line	:	1023 MAIN PLAZA DR
Second Line	:
City	:	WENTZVILLE
State	:	MO
Zip	:	63385-1170
Country	:	US
Telephone Number	:	636-639-8944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 PROSPECT LAKES DR
Second Line	:
City	:	WENTZVILLE
State	:	MO
Zip	:	63385-4907
Country	:	US
Telephone Number	:	636-544-2576
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. LEAH OWENS
Credential	:	DC
Telephone Number	:	636-544-2576

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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