Provider Demographics
NPI:1073616884
Name:WEBER, LEAH LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:LYNN
Last Name:WEBER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LEAH
Other - Middle Name:LYNN
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7628 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2815
Mailing Address - Country:US
Mailing Address - Phone:630-649-1478
Mailing Address - Fax:630-539-7159
Practice Address - Street 1:253 BUNTING LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1423
Practice Address - Country:US
Practice Address - Phone:630-539-6705
Practice Address - Fax:630-539-7159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38008075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK03744Medicare ID - Type Unspecified