Provider Demographics
NPI:1063494946
Name:LEGAT, JOHN K (DC, PC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:LEGAT
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 AMBLESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-6736
Mailing Address - Country:US
Mailing Address - Phone:541-736-3962
Mailing Address - Fax:
Practice Address - Street 1:1142 WILLAGILLESPIE RD
Practice Address - Street 2:SUITE 10
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2142
Practice Address - Country:US
Practice Address - Phone:541-343-4913
Practice Address - Fax:541-343-5426
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272750111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU30036Medicare UPIN
OR000QGFTGMedicare ID - Type Unspecified