Provider Demographics
NPI:1326230962
Name:LEACH-GREEN, DEBORAH LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNN
Last Name:LEACH-GREEN
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 1:1075 WASHINGTON ST
Mailing Address - Street 2:112
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3689
Mailing Address - Country:US
Mailing Address - Phone:541-357-5552
Mailing Address - Fax:541-357-5422
Practice Address - Street 1:1075 WASHINGTON ST
Practice Address - Street 2:112
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3689
Practice Address - Country:US
Practice Address - Phone:541-357-5552
Practice Address - Fax:541-357-5422
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA184970111N00000X
OR4071111N00000X
WACH60175945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU18953Medicare UPIN