Provider Demographics
NPI:1609855097
Name:LEAVENS, BART WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:WILLIAM
Last Name:LEAVENS
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 1:326 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4436
Mailing Address - Country:US
Mailing Address - Phone:563-241-4295
Mailing Address - Fax:563-242-9122
Practice Address - Street 1:326 3RD AVE S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4436
Practice Address - Country:US
Practice Address - Phone:563-241-4295
Practice Address - Fax:563-242-9122
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1168823Medicaid
IAU69110Medicare UPIN
IA1168823Medicaid