Provider Demographics
NPI:1992706790
Name:ALEXANDER LEYBOVICH
Entity type:Organization
Organization Name:ALEXANDER LEYBOVICH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYBOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-664-9089
Mailing Address - Street 1:870 N COIT RD
Mailing Address - Street 2:SUITE 2651
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5420
Mailing Address - Country:US
Mailing Address - Phone:972-664-9089
Mailing Address - Fax:972-664-9014
Practice Address - Street 1:870 N COIT RD
Practice Address - Street 2:SUITE 2651
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5420
Practice Address - Country:US
Practice Address - Phone:972-664-9089
Practice Address - Fax:972-664-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606114OtherBCBS
TX606114OtherBCBS
TX609442Medicare PIN