Provider Demographics
NPI:1487672093
Name:WEISS, LEONARD L (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:L
Last Name:WEISS
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 1:2322 E KIMBERLY RD
Mailing Address - Street 2:SUITE 120N
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-7205
Mailing Address - Country:US
Mailing Address - Phone:563-324-2225
Mailing Address - Fax:563-359-3398
Practice Address - Street 1:2322 E KIMBERLY RD
Practice Address - Street 2:SUITE 120N
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-7205
Practice Address - Country:US
Practice Address - Phone:563-324-2225
Practice Address - Fax:563-359-3398
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0457960Medicaid
IA38778OtherBLUE CROSS/BLUE SHIELD
IA0457960Medicaid
IAI15175Medicare ID - Type Unspecified
IAU89784Medicare UPIN
IL039009558Medicaid