Provider Demographics
NPI:1710054408
Name:LEIB LTD
Entity Type:Organization
Organization Name:LEIB LTD
Other - Org Name:ROSEMONT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LEIB
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:757-431-2225
Mailing Address - Street 1:397 LITTLE NECK RD
Mailing Address - Street 2:3400 BUILDING, SUITE 108
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5765
Mailing Address - Country:US
Mailing Address - Phone:757-431-2225
Mailing Address - Fax:757-431-9314
Practice Address - Street 1:397 LITTLE NECK RD
Practice Address - Street 2:3400 BUILDING, SUITE 108
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5765
Practice Address - Country:US
Practice Address - Phone:757-431-2225
Practice Address - Fax:757-431-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08440Medicare PIN
VAX78000Medicare UPIN