Provider Demographics
NPI:1891787826
Name:KOFORD, LEANN JANET (DC)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:JANET
Last Name:KOFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LEONE
Other - Middle Name:JANET
Other - Last Name:ROWE-KOFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:203 OAK ST
Mailing Address - Street 2:PO BOX 185
Mailing Address - City:DANUBE
Mailing Address - State:MN
Mailing Address - Zip Code:56230-0185
Mailing Address - Country:US
Mailing Address - Phone:320-826-2320
Mailing Address - Fax:775-320-5285
Practice Address - Street 1:203 OAK ST
Practice Address - Street 2:
Practice Address - City:DANUBE
Practice Address - State:MN
Practice Address - Zip Code:56230-0185
Practice Address - Country:US
Practice Address - Phone:320-826-2320
Practice Address - Fax:775-320-5285
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T65726Medicare UPIN