Provider Demographics
NPI:1699137174
Name:LEGACY CHIROPRACTIC CENTER PLC
Entity type:Organization
Organization Name:LEGACY CHIROPRACTIC CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELCESER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-310-6863
Mailing Address - Street 1:925 N LAPEER RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-3645
Mailing Address - Country:US
Mailing Address - Phone:248-332-0111
Mailing Address - Fax:248-332-0880
Practice Address - Street 1:925 N LAPEER RD
Practice Address - Street 2:SUITE 117
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-3645
Practice Address - Country:US
Practice Address - Phone:248-332-0111
Practice Address - Fax:248-332-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty