Provider Demographics
NPI:1265649354
Name:LEITNER-RZEPA, PAMELA J (DC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:LEITNER-RZEPA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03862-2445
Mailing Address - Country:US
Mailing Address - Phone:603-964-1103
Mailing Address - Fax:
Practice Address - Street 1:216 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:NORTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03862-2445
Practice Address - Country:US
Practice Address - Phone:603-964-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4830797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH043379936OtherTAX ID