Provider Demographics
NPI:1942577374
Name:WALTON, LEANNE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:MARIE
Last Name:WALTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 N SUGAR GROVE PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-8111
Mailing Address - Country:US
Mailing Address - Phone:309-696-8803
Mailing Address - Fax:
Practice Address - Street 1:522 N SUGAR GROVE PKWY STE C
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554
Practice Address - Country:US
Practice Address - Phone:309-696-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1942577374OtherINDIVIDUAL NPI