Provider Demographics
NPI:1447395686
Name:LEIGH, JOHN (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LEIGH
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 1:13702 47TH ST NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9499
Mailing Address - Country:US
Mailing Address - Phone:763-497-2787
Mailing Address - Fax:763-497-4325
Practice Address - Street 1:400 CENTRAL AVE E
Practice Address - Street 2:SUITE 70
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-9525
Practice Address - Country:US
Practice Address - Phone:763-497-2787
Practice Address - Fax:763-497-4325
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3455111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN226943100Medicaid
U87344Medicare UPIN
350002474Medicare ID - Type Unspecified