Provider Demographics
NPI:1861673717
Name:LEAF CHIROPRACTIC & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:LEAF CHIROPRACTIC & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEAF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-363-9705
Mailing Address - Street 1:1012 STATE ROUTE 521
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015
Mailing Address - Country:US
Mailing Address - Phone:740-363-9705
Mailing Address - Fax:740-368-9297
Practice Address - Street 1:1012 STATE ROUTE
Practice Address - Street 2:SUITE 101
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015
Practice Address - Country:US
Practice Address - Phone:740-363-9705
Practice Address - Fax:740-368-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP01781Medicare PIN
OHU78901Medicare UPIN