Provider Demographics
NPI:1841394947
Name:PORTER, LELAND L (DC)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:L
Last Name:PORTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:L
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:121 S. CHRISTIAN
Mailing Address - Street 2:PO BOX 743
Mailing Address - City:MOUNDRIDGE
Mailing Address - State:KS
Mailing Address - Zip Code:67107-0743
Mailing Address - Country:US
Mailing Address - Phone:620-345-3000
Mailing Address - Fax:620-345-3042
Practice Address - Street 1:121 S. CHRISTIAN AVE.
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-0743
Practice Address - Country:US
Practice Address - Phone:620-345-3000
Practice Address - Fax:620-345-3042
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU605083Medicare UPIN