Provider Demographics
NPI:1558491753
Name:LEATH, JARED RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:RYAN
Last Name:LEATH
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 1:6537 N COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2380
Mailing Address - Country:US
Mailing Address - Phone:816-587-7711
Mailing Address - Fax:816-587-3460
Practice Address - Street 1:6537 N COSBY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2380
Practice Address - Country:US
Practice Address - Phone:816-587-7711
Practice Address - Fax:816-587-3460
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017007846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty