Provider Demographics
NPI:1235279548
Name:LEASENBY, TIMOTHY BRYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BRYAN
Last Name:LEASENBY
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 1:3831 MCCOY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4105
Mailing Address - Country:US
Mailing Address - Phone:630-851-9222
Mailing Address - Fax:630-851-9281
Practice Address - Street 1:3831 MCCOY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4105
Practice Address - Country:US
Practice Address - Phone:630-851-9222
Practice Address - Fax:630-851-9281
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004891111NI0900X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL500250Medicare ID - Type Unspecified
ILT05703Medicare UPIN