Provider Demographics
NPI:1265630743
Name:LEONARD CHIROPRACTIC
Entity Type:Organization
Organization Name:LEONARD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-895-3500
Mailing Address - Street 1:21800 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3331
Mailing Address - Country:US
Mailing Address - Phone:440-895-3500
Mailing Address - Fax:440-895-3501
Practice Address - Street 1:21800 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3331
Practice Address - Country:US
Practice Address - Phone:440-895-3500
Practice Address - Fax:440-895-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9348011Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER