Provider Demographics
NPI:1326139536
Name:LECLERC, BYRON W (DC)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:W
Last Name:LECLERC
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 1:356 SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-4537
Mailing Address - Country:US
Mailing Address - Phone:913-682-4848
Mailing Address - Fax:913-682-1610
Practice Address - Street 1:356 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4537
Practice Address - Country:US
Practice Address - Phone:913-682-4848
Practice Address - Fax:913-682-1610
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO24066014OtherBLUE CROSS BLUE SHEILD KC
KS055883Medicare ID - Type Unspecified
KS1326139536Medicare PIN