Provider Demographics
NPI:1528000163
Name:LEU, DAVID J (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:LEU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:817 W WALNUT ST
Mailing Address - Street 2:STE 4
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6549
Mailing Address - Country:US
Mailing Address - Phone:423-262-8300
Mailing Address - Fax:423-262-8786
Practice Address - Street 1:817 W WALNUT ST
Practice Address - Street 2:STE 4
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6549
Practice Address - Country:US
Practice Address - Phone:423-262-8300
Practice Address - Fax:423-262-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4122586OtherBCBS
TN147297OtherCIGNA
TN4122586OtherBCBS
TNV05507Medicare UPIN