Provider Demographics
NPI:1245411735
Name:LEIPHON, ADAM JOSEPH (ATC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JOSEPH
Last Name:LEIPHON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 UNIVERSITY AVE
Mailing Address - Street 2:SPORTS CENTER 139
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-5000
Mailing Address - Country:US
Mailing Address - Phone:218-281-8427
Mailing Address - Fax:
Practice Address - Street 1:2900 UNIVERSITY AVE
Practice Address - Street 2:SPORTS CENTER 139
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-5000
Practice Address - Country:US
Practice Address - Phone:218-281-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer