Provider Demographics
NPI:1093086001
Name:LEIBLE, ZACHARY (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:LEIBLE
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 1:141 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1216
Mailing Address - Country:US
Mailing Address - Phone:270-527-2007
Mailing Address - Fax:270-527-8324
Practice Address - Street 1:141 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025
Practice Address - Country:US
Practice Address - Phone:270-527-2007
Practice Address - Fax:270-527-8324
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5322111N00000X
KY249463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100244920Medicaid