Provider Demographics
NPI:1497858880
Name:LEINGANG, ANDREA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ROSE
Last Name:LEINGANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3310
Mailing Address - Country:US
Mailing Address - Phone:701-663-0488
Mailing Address - Fax:701-751-4129
Practice Address - Street 1:307 1ST ST NE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3310
Practice Address - Country:US
Practice Address - Phone:701-663-0488
Practice Address - Fax:701-751-4129
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14480Medicaid
30196OtherBCBS
N713245Medicare PIN
MN453983400Medicaid