Provider Demographics
NPI:1760572218
Name:LEASE, HAROLD W (DC)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:W
Last Name:LEASE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:137 N KANSAS ST
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:WALSH
Mailing Address - State:CO
Mailing Address - Zip Code:81090-0189
Mailing Address - Country:US
Mailing Address - Phone:719-324-5242
Mailing Address - Fax:719-324-5621
Practice Address - Street 1:137 N. KANSAS ST.
Practice Address - Street 2:
Practice Address - City:WALSH
Practice Address - State:CO
Practice Address - Zip Code:81090-0189
Practice Address - Country:US
Practice Address - Phone:719-324-5242
Practice Address - Fax:719-324-5621
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18373Medicare ID - Type Unspecified