Provider Demographics
NPI:1902030927
Name:MATTHEW R. LEONARD, S.C.
Entity Type:Organization
Organization Name:MATTHEW R. LEONARD, S.C.
Other - Org Name:MOTION CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-539-6210
Mailing Address - Street 1:102 N STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREEBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62243-1246
Mailing Address - Country:US
Mailing Address - Phone:618-539-6210
Mailing Address - Fax:618-539-6276
Practice Address - Street 1:102 N STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREEBURG
Practice Address - State:IL
Practice Address - Zip Code:62243-1246
Practice Address - Country:US
Practice Address - Phone:618-539-6210
Practice Address - Fax:618-539-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty