Provider Demographics
NPI:1619919974
Name:LEAGO, ROSS ALLEN III (DC)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:ALLEN
Last Name:LEAGO
Suffix:III
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 1:301 GLADE BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4162
Mailing Address - Country:US
Mailing Address - Phone:713-501-8493
Mailing Address - Fax:
Practice Address - Street 1:1701 FAIRWAY STREET
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4661
Practice Address - Country:US
Practice Address - Phone:281-331-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9862111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician