Provider Demographics
NPI:1154382984
Name:LECLAIR, LEONARD J (DC)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:J
Last Name:LECLAIR
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 1:806 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9550
Mailing Address - Country:US
Mailing Address - Phone:989-846-4660
Mailing Address - Fax:989-846-4668
Practice Address - Street 1:806 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9550
Practice Address - Country:US
Practice Address - Phone:989-846-4660
Practice Address - Fax:989-846-4668
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005142111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1795778Medicaid
MI1795778Medicaid
MI0Z65002Medicare PIN