Provider Demographics
NPI:1578687190
Name:LEAHY, JOSEPH PATRICK (JOSEPH LEAHY)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:LEAHY
Suffix:
Gender:M
Credentials:JOSEPH LEAHY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15729 LOS GATOS BOULEVARD
Mailing Address - Street 2:#100
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2600
Mailing Address - Country:US
Mailing Address - Phone:408-358-7900
Mailing Address - Fax:408-358-4020
Practice Address - Street 1:15729 LOS GATOS BLVD
Practice Address - Street 2:#100
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2555
Practice Address - Country:US
Practice Address - Phone:408-358-7900
Practice Address - Fax:408-358-4020
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0152850Medicare ID - Type Unspecified
CAT05702Medicare UPIN