Provider Demographics
NPI:1376674077
Name:GRACE LEICHLITER, JOYCE A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:A
Last Name:GRACE LEICHLITER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JOYCE
Other - Middle Name:A
Other - Last Name:LEICHLITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:26105 TATTERSALL LN
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-6204
Mailing Address - Country:US
Mailing Address - Phone:941-276-1549
Mailing Address - Fax:
Practice Address - Street 1:119 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3654
Practice Address - Country:US
Practice Address - Phone:941-639-1770
Practice Address - Fax:941-639-1770
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU40943Medicare UPIN
55228AMedicare ID - Type Unspecified