Provider Demographics
NPI:1063859619
Name:LEON CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:LEON CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-689-1000
Mailing Address - Street 1:213 HALLOCK RD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3000
Mailing Address - Country:US
Mailing Address - Phone:631-689-1000
Mailing Address - Fax:631-444-0885
Practice Address - Street 1:213 HALLOCK RD
Practice Address - Street 2:SUITE 4B
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3000
Practice Address - Country:US
Practice Address - Phone:631-689-1000
Practice Address - Fax:631-444-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU98315Medicare UPIN
NYX6T061Medicare PIN