MEDICARE: JERONICA LEONARD

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	2734	AL

General Provider Information

NPI Number	:	1669193611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERONICA LEONARD

Provider Business Mailing Address
First Line	:	2013 HIGHWAY 45 N STE 1
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2239
Country	:	US
Telephone Number	:	662-848-2057
Fax Number	:	662-327-6587

Provider Business Practice Location Address
First Line	:	2013 HIGHWAY 45 N STE 1
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2239
Country	:	US
Telephone Number	:	662-848-2057
Fax Number	:	662-327-6587

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

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	09/08/2022

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Directions to “ JERONICA LEONARD ” Practice Location

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