Provider Demographics
NPI:1588133565
Name:LEANNA, CODY ROBERT (DC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:ROBERT
Last Name:LEANNA
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 1:1900 W RYAN RD
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8233
Mailing Address - Country:US
Mailing Address - Phone:414-761-5777
Mailing Address - Fax:414-761-7915
Practice Address - Street 1:1900 W RYAN RD
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-8233
Practice Address - Country:US
Practice Address - Phone:414-761-5777
Practice Address - Fax:414-761-7915
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5393-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor