Provider Demographics
NPI:1144564089
Name:JEREMY LEIMBACK DC PC
Entity Type:Organization
Organization Name:JEREMY LEIMBACK DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIMBACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-593-5194
Mailing Address - Street 1:205 W RANDOLPH ST
Mailing Address - Street 2:1205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1867
Mailing Address - Country:US
Mailing Address - Phone:312-593-5194
Mailing Address - Fax:877-575-6373
Practice Address - Street 1:205 W RANDOLPH ST
Practice Address - Street 2:1205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1867
Practice Address - Country:US
Practice Address - Phone:312-593-5194
Practice Address - Fax:877-575-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038011445OtherLICENSE