Provider Demographics
NPI:1053329433
Name:NORTHCUTT, LELAND J (DC)
Entity Type:Individual
Prefix:MR
First Name:LELAND
Middle Name:J
Last Name:NORTHCUTT
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 1:1014 S CHANCERY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110
Mailing Address - Country:US
Mailing Address - Phone:931-473-2345
Mailing Address - Fax:931-473-4254
Practice Address - Street 1:1014 S CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:931-473-2345
Practice Address - Fax:931-473-4254
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673405Medicaid
TN3673405Medicare ID - Type Unspecified
TN3673405Medicaid