Provider Demographics
NPI:1972557361
Name:LEICHTER, ALAN SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SCOTT
Last Name:LEICHTER
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 1:1622 MISHAWAKA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-1427
Mailing Address - Country:US
Mailing Address - Phone:574-288-1234
Mailing Address - Fax:574-288-4821
Practice Address - Street 1:1622 MISHAWAKA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-1427
Practice Address - Country:US
Practice Address - Phone:574-288-1234
Practice Address - Fax:574-288-4821
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100366010Medicaid
IN100366010Medicaid
IN164820AMedicare PIN