Provider Demographics
NPI:1043435738
Name:LEATHERS, DONALD T (ND)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:T
Last Name:LEATHERS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 S MAIN ST
Mailing Address - Street 2:SUITE #10
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532
Mailing Address - Country:US
Mailing Address - Phone:435-259-8123
Mailing Address - Fax:
Practice Address - Street 1:76 S MAIN ST
Practice Address - Street 2:SUITE #10
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532
Practice Address - Country:US
Practice Address - Phone:435-259-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3649277106175F00000X
OR0887175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath