Provider Demographics
NPI:1578747218
Name:LEASEBURGE, EMORY LEWIS (DC)
Entity Type:Individual
Prefix:
First Name:EMORY
Middle Name:LEWIS
Last Name:LEASEBURGE
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 1:533 N JEFFERSON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1166
Mailing Address - Country:US
Mailing Address - Phone:304-646-6551
Mailing Address - Fax:
Practice Address - Street 1:533 N JEFFERSON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1166
Practice Address - Country:US
Practice Address - Phone:304-646-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor