Provider Demographics
NPI:1376606848
Name:LEPPEN, CECILIA INGRID (DC)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:INGRID
Last Name:LEPPEN
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 1:15461 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2662
Mailing Address - Country:US
Mailing Address - Phone:734-246-7711
Mailing Address - Fax:734-246-9287
Practice Address - Street 1:15461 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2662
Practice Address - Country:US
Practice Address - Phone:734-246-7711
Practice Address - Fax:734-246-9287
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI027564OtherDMC
MI6097892OtherCIGNA
MIOH25308OtherBLUE CROSS BLUE SHIELD
MIP102140OtherBCN
MI5511712OtherATENA
MI5511712OtherATENA