MEDICARE: MICHAEL A LEAKE DC PC

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1477955052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL A LEAKE DC PC

Provider Business Mailing Address
First Line	:	4219 NW 21ST ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-3439
Country	:	US
Telephone Number	:	412-260-6120
Fax Number	:

Provider Business Practice Location Address
First Line	:	4219 NW 21ST ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-3439
Country	:	US
Telephone Number	:	412-260-6120
Fax Number	:	412-291-1150

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL LEAKE
Credential	:	DC
Telephone Number	:	412-260-6120

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	09/25/2014

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