Provider Demographics
NPI:1093834079
Name:LEGER, DAVID D (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:LEGER
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 1:2100 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538
Mailing Address - Country:US
Mailing Address - Phone:630-906-1700
Mailing Address - Fax:630-906-9831
Practice Address - Street 1:2100 BASELINE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538
Practice Address - Country:US
Practice Address - Phone:630-906-1700
Practice Address - Fax:630-906-9831
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005668111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211801Medicare ID - Type Unspecified
ILK18120Medicare UPIN