MEDICARE: DR. LEAH WILLETT 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	111NR0400X	Rehabilitation Chiropractor	14660	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14660	OTHER	TX	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1528651403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEAH WILLETT DC

Provider Business Mailing Address
First Line	:	PO BOX 700688
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78270-0688
Country	:	US
Telephone Number	:	210-318-3007
Fax Number	:	210-468-0682

Provider Business Practice Location Address
First Line	:	8744 MEDICAL CITY WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2414
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:	866-313-3397

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

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	04/02/2025

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