Provider Demographics
NPI:1891066189
Name:LEFFLER, ERICK (DC)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:
Last Name:LEFFLER
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:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-0091
Mailing Address - Country:US
Mailing Address - Phone:574-457-7472
Mailing Address - Fax:574-457-7103
Practice Address - Street 1:201 E PALM DR STE E
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567
Practice Address - Country:US
Practice Address - Phone:574-457-7472
Practice Address - Fax:574-457-7103
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002619A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201051710Medicaid