Provider Demographics
NPI:1063543221
Name:SAULTER, LEONARD GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:GEORGE
Last Name:SAULTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FUNDY RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1796
Mailing Address - Country:US
Mailing Address - Phone:207-781-2003
Mailing Address - Fax:207-781-2149
Practice Address - Street 1:3 FUNDY RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1796
Practice Address - Country:US
Practice Address - Phone:207-781-2003
Practice Address - Fax:207-781-2149
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME595111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002320OtherANTHEM
ME010390802OtherTAX ID
ME113840000Medicaid
ME010390802OtherTAX ID