Provider Demographics
NPI:1194859959
Name:LEITZKE, ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:LEITZKE
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 1:102 SLEEPY HOLLOW DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5841
Mailing Address - Country:US
Mailing Address - Phone:302-449-1555
Mailing Address - Fax:302-449-2908
Practice Address - Street 1:102 SLEEPY HOLLOW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5841
Practice Address - Country:US
Practice Address - Phone:302-449-1555
Practice Address - Fax:302-449-2908
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEV08431Medicare UPIN
DEG02241A01Medicare ID - Type UnspecifiedINDIVIDUAL