Provider Demographics
NPI:1922104538
Name:LEAGUE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:LEAGUE CHIROPRACTIC, PLLC
Other - Org Name:CHESHIRE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-355-9911
Mailing Address - Street 1:815 COURT ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1770
Mailing Address - Country:US
Mailing Address - Phone:603-355-9911
Mailing Address - Fax:603-355-9916
Practice Address - Street 1:815 COURT ST UNIT 1
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1770
Practice Address - Country:US
Practice Address - Phone:603-355-9911
Practice Address - Fax:603-355-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH712-0104111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty