Provider Demographics
NPI:1376505388
Name:LEACH, ALLISON (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:LEACH
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 1:10504 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5603
Mailing Address - Country:US
Mailing Address - Phone:772-337-2748
Mailing Address - Fax:772-337-1764
Practice Address - Street 1:10504 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5603
Practice Address - Country:US
Practice Address - Phone:772-337-2748
Practice Address - Fax:772-337-1764
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0008231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70263OtherBLUE CROSS BLUE SHIELD
FLU87827Medicare UPIN
FL70263AMedicare ID - Type Unspecified