Provider Demographics
NPI:1063120178
Name:LEACH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LEACH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF THE ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-294-4197
Mailing Address - Street 1:838 W DRAKE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5539
Mailing Address - Country:US
Mailing Address - Phone:970-294-4197
Mailing Address - Fax:970-294-4186
Practice Address - Street 1:838 W DRAKE RD STE 105
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5539
Practice Address - Country:US
Practice Address - Phone:970-294-4197
Practice Address - Fax:970-294-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty