Provider Demographics
NPI:1568449767
Name:LEADER, BARRY T (DC, PC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:T
Last Name:LEADER
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 NIXON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9759
Mailing Address - Country:US
Mailing Address - Phone:315-378-0617
Mailing Address - Fax:315-378-0619
Practice Address - Street 1:4651 NIXON PARK DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9759
Practice Address - Country:US
Practice Address - Phone:315-378-0617
Practice Address - Fax:315-378-0619
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94915Medicare UPIN
NYDD4938Medicare ID - Type Unspecified