Provider Demographics
NPI:1376516310
Name:LEISTER, MICHAEL K (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:LEISTER
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 1:5011 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4522
Mailing Address - Country:US
Mailing Address - Phone:717-657-1000
Mailing Address - Fax:717-657-1199
Practice Address - Street 1:5011 LOCUST LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4522
Practice Address - Country:US
Practice Address - Phone:717-657-1000
Practice Address - Fax:717-657-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001815L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA024159Medicare ID - Type Unspecified
PAT27120Medicare UPIN