Provider Demographics
NPI:1275734808
Name:LEASENBY, MICHAEL R (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
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 1:3737 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6402
Mailing Address - Country:US
Mailing Address - Phone:309-762-9662
Mailing Address - Fax:
Practice Address - Street 1:3737 38TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6402
Practice Address - Country:US
Practice Address - Phone:309-762-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111NI0900X
IL111NN1001X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NI0900XChiropractic ProvidersChiropractorInternist
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic