Provider Demographics
NPI:1508006016
Name:LEBA, JACOB J (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:J
Last Name:LEBA
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 1:35496 US HIGHWAY 177
Mailing Address - Street 2:
Mailing Address - City:ASHER
Mailing Address - State:OK
Mailing Address - Zip Code:74826-6603
Mailing Address - Country:US
Mailing Address - Phone:405-974-0600
Mailing Address - Fax:
Practice Address - Street 1:11 W MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-2025
Practice Address - Country:US
Practice Address - Phone:405-273-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor