Provider Demographics
NPI:1659762920
Name:LEON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LEON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-652-5687
Mailing Address - Street 1:606 E PLATT ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:606 E PLATT ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2415
Practice Address - Country:US
Practice Address - Phone:563-652-5687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04417111N00000X
IA06673111N00000X
IA007213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA11063Medicaid
IAIA18426Medicaid
IA1234OtherWELLMARK BLUE CROSS BLUE SHIELD
IA1255564217OtherNPI
IA04516OtherWELLMARK BLUE CROSS BLUE SHIELD
IA1801911011OtherNPI
IA1932154044OtherNPI
IA02375OtherWELLMARK BLUE CROSS BLUE SHIELD
IAIA01151Medicaid
IA02375Medicare PIN
IA04516OtherWELLMARK BLUE CROSS BLUE SHIELD
IA1234OtherWELLMARK BLUE CROSS BLUE SHIELD