Provider Demographics
NPI:1932290905
Name:CROOKS, LELAND S (DC)
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:S
Last Name:CROOKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4025
Mailing Address - Country:US
Mailing Address - Phone:480-730-8481
Mailing Address - Fax:480-730-0419
Practice Address - Street 1:2740 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4025
Practice Address - Country:US
Practice Address - Phone:480-730-8481
Practice Address - Fax:480-730-0419
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0087600OtherBCBS
AZAZ0087600OtherBCBS