Provider Demographics
NPI:1851436042
Name:LEAHY, MARIANN (DC)
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:LEAHY
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 1:60 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6814
Mailing Address - Country:US
Mailing Address - Phone:847-221-2225
Mailing Address - Fax:847-358-3544
Practice Address - Street 1:60 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6814
Practice Address - Country:US
Practice Address - Phone:847-221-2225
Practice Address - Fax:847-358-3544
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018730101YP2500X
IL038-009732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU95109Medicare UPIN
IL205669Medicare ID - Type Unspecified