MEDICARE: RUSSELL A LEBLANC D.C.

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	2301006832	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
2	950D510120	OTHER	MI	BLUE CROSS AND BLUE SHIELD OF MICHIGAN

General Provider Information

NPI Number	:	1659374064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL A LEBLANC D.C.

Provider Business Mailing Address
First Line	:	5585 E HOHNKE RD
Second Line	:
City	:	CEDAR
State	:	MI
Zip	:	49621-9607
Country	:	US
Telephone Number	:	231-256-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	489 W MAIN ST
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653-9740
Country	:	US
Telephone Number	:	231-256-7877
Fax Number	:	231-256-9529

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2008

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Directions to “ RUSSELL A LEBLANC D.C.” Practice Location

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