Provider Demographics
NPI:1578793287
Name:LEIMBACK, JEREMY (DC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:LEIMBACK
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 1:205 W RANDOLPH ST
Mailing Address - Street 2:2010
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1867
Mailing Address - Country:US
Mailing Address - Phone:312-593-5194
Mailing Address - Fax:877-575-6373
Practice Address - Street 1:205 W RANDOLPH ST
Practice Address - Street 2:2010
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1867
Practice Address - Country:US
Practice Address - Phone:312-593-5194
Practice Address - Fax:877-575-6373
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038011445OtherILLINOIS LICENSE #