Provider Demographics
NPI:1508179102
Name:LEONHARDT, DEBORAH (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:LEONHARDT
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 1:1425 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54829-7212
Mailing Address - Country:US
Mailing Address - Phone:715-822-2135
Mailing Address - Fax:
Practice Address - Street 1:1425 2ND AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:WI
Practice Address - Zip Code:54829-7212
Practice Address - Country:US
Practice Address - Phone:715-822-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4618-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor