Provider Demographics
NPI:1417009523
Name:LEEPER, ROBERT JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:LEEPER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 SOUTH FRIENDSHIP ROAD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003
Mailing Address - Country:US
Mailing Address - Phone:270-554-9637
Mailing Address - Fax:270-554-5337
Practice Address - Street 1:229 SOUTH FRIENDSHIP ROAD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-554-9637
Practice Address - Fax:270-554-5337
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000062868OtherANTHEM BLUE CROSS
GA350048310Medicare PIN
KYU39425Medicare UPIN
KY6064501Medicare PIN