Provider Demographics
NPI:1790822310
Name:LEBIECKI, CHRISTINE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:LEBIECKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HERCULES DR
Mailing Address - Street 2:STE 1B
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446
Mailing Address - Country:US
Mailing Address - Phone:802-860-0382
Mailing Address - Fax:802-655-0154
Practice Address - Street 1:525 HERCULES DR
Practice Address - Street 2:STE 1B
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-860-0382
Practice Address - Fax:802-655-0154
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060001073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009535Medicaid
VT1009535Medicaid