Provider Demographics
NPI:1477504843
Name:LEACH, JEFFREY CLARENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CLARENCE
Last Name:LEACH
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 1:3140 HARBOR LN N STE 102
Mailing Address - Street 2:SUITE #102
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5118
Mailing Address - Country:US
Mailing Address - Phone:763-230-7333
Mailing Address - Fax:763-230-7335
Practice Address - Street 1:3140 HARBOR LN N
Practice Address - Street 2:SUITE #102
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5118
Practice Address - Country:US
Practice Address - Phone:763-230-7333
Practice Address - Fax:763-230-7335
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor