Provider Demographics
NPI:1962420232
Name:LEACH, KEVIN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:LEACH
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 1:4011 ARCTIC BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5701
Mailing Address - Country:US
Mailing Address - Phone:907-561-7041
Mailing Address - Fax:907-561-2349
Practice Address - Street 1:4011 ARCTIC BLVD
Practice Address - Street 2:STE 203
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5701
Practice Address - Country:US
Practice Address - Phone:907-561-7041
Practice Address - Fax:907-561-2349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH7932Medicaid
AK920176908Medicare UPIN
AK151994Medicare ID - Type UnspecifiedMEDICARE BILLING ID