Provider Demographics
NPI:1407993041
Name:LEEGAARD, JOHN DALE
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DALE
Last Name:LEEGAARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:IA
Mailing Address - Zip Code:50450-1312
Mailing Address - Country:US
Mailing Address - Phone:641-592-2600
Mailing Address - Fax:641-592-2650
Practice Address - Street 1:209 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:IA
Practice Address - Zip Code:50450-1312
Practice Address - Country:US
Practice Address - Phone:641-592-2600
Practice Address - Fax:641-592-2650
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor