Provider Demographics
NPI:1760666887
Name:LEINGANG CHIROPRACTIC & WELLNESS, PC
Entity Type:Organization
Organization Name:LEINGANG CHIROPRACTIC & WELLNESS, PC
Other - Org Name:LEINGANG CHIROPRACTIC AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEINGANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-663-0488
Mailing Address - Street 1:307 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3310
Mailing Address - Country:US
Mailing Address - Phone:701-663-0488
Mailing Address - Fax:701-751-4129
Practice Address - Street 1:307 1ST ST NE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3310
Practice Address - Country:US
Practice Address - Phone:701-663-0488
Practice Address - Fax:701-751-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14475Medicaid
ND30196OtherBCBS OF ND
ND14475Medicaid