Provider Demographics
NPI:1801222187
Name:DR. BRYAN E LEADER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DR. BRYAN E LEADER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEADER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-730-8948
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-0862
Mailing Address - Country:US
Mailing Address - Phone:315-730-8948
Mailing Address - Fax:
Practice Address - Street 1:2115 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-9410
Practice Address - Country:US
Practice Address - Phone:315-730-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty