Provider Demographics
NPI:1386683274
Name:ROESSNER, LEIGH SUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:SUSAN
Last Name:ROESSNER
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 1:840 PINNACLE CT
Mailing Address - Street 2:STE 5A
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-3322
Mailing Address - Country:US
Mailing Address - Phone:702-346-6114
Mailing Address - Fax:
Practice Address - Street 1:840 PINNACLE CT
Practice Address - Street 2:SUITE 5A
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-3303
Practice Address - Country:US
Practice Address - Phone:702-346-5030
Practice Address - Fax:702-345-3256
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVBO1006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV38464Medicare PIN