Provider Demographics
NPI:1164879516
Name:LEICHLITER, ROBERT RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAYMOND
Last Name:LEICHLITER
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 1:927 W HIGH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1856
Mailing Address - Country:US
Mailing Address - Phone:814-419-4057
Mailing Address - Fax:
Practice Address - Street 1:927 W HIGH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1856
Practice Address - Country:US
Practice Address - Phone:814-419-4057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103127650-0001Medicaid