Provider Demographics
NPI:1376721530
Name:LEASEBURGE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LEASEBURGE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMORY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:LEASEBURGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-646-6551
Mailing Address - Street 1:533 N JEFFERSON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1166
Mailing Address - Country:US
Mailing Address - Phone:304-646-6551
Mailing Address - Fax:
Practice Address - Street 1:533 N JEFFERSON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1166
Practice Address - Country:US
Practice Address - Phone:304-646-6551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty