Provider Demographics
NPI:1346534039
Name:LEYDER, LYNNMARIE SKIPPER (DC)
Entity Type:Individual
Prefix:
First Name:LYNNMARIE
Middle Name:SKIPPER
Last Name:LEYDER
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 1:542 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-1547
Mailing Address - Country:US
Mailing Address - Phone:616-887-2178
Mailing Address - Fax:616-887-2456
Practice Address - Street 1:542 S STATE ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-1547
Practice Address - Country:US
Practice Address - Phone:616-887-2178
Practice Address - Fax:616-887-2456
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor