Provider Demographics
NPI:1255501888
Name:DR. LEIGH A. ELCESER P.C
Entity Type:Organization
Organization Name:DR. LEIGH A. ELCESER P.C
Other - Org Name:JOSLYN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELCESER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-332-0111
Mailing Address - Street 1:1044 JOSLYN AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-2930
Mailing Address - Country:US
Mailing Address - Phone:248-332-0111
Mailing Address - Fax:248-332-0880
Practice Address - Street 1:1044 JOSLYN AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2930
Practice Address - Country:US
Practice Address - Phone:248-332-0111
Practice Address - Fax:248-332-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILE007043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3202565Medicaid
MI3202565Medicaid