Provider Demographics
NPI:1619982329
Name:LEAGUE, ROBERT S (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:LEAGUE
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 1:815 COURT ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1770
Mailing Address - Country:US
Mailing Address - Phone:603-355-9911
Mailing Address - Fax:603-355-9916
Practice Address - Street 1:423 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3944
Practice Address - Country:US
Practice Address - Phone:603-355-9911
Practice Address - Fax:603-355-9916
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7120104111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHV11408Medicare UPIN
NH6479971OtherCIGNA