Provider Demographics
NPI:1346910486
Name:LEACH, DANIEL CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CHRISTOPHER
Last Name:LEACH
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 1:1502 PREHISTORIC HILL DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2288
Mailing Address - Country:US
Mailing Address - Phone:636-525-1175
Mailing Address - Fax:
Practice Address - Street 1:1006 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-2432
Practice Address - Country:US
Practice Address - Phone:636-525-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021036794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor