MEDICARE: DR. ERICA LYNN LEISER 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	111N00000X	Chiropractor	2021034340	MO

General Provider Information

NPI Number	:	1497422547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA LYNN LEISER DC

Provider Business Mailing Address
First Line	:	1362 S 5TH ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6257 RONALD REAGAN DR
Second Line	:
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-2665
Country	:	US
Telephone Number	:	636-625-1772
Fax Number	:

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

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	10/07/2021

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