Provider Demographics
NPI:1942823695
Name:LEALI, SETH ANDREW
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:ANDREW
Last Name:LEALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 LANSING ST SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2014
Mailing Address - Country:US
Mailing Address - Phone:616-666-0721
Mailing Address - Fax:
Practice Address - Street 1:610 MARYLAND AVE NE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-6052
Practice Address - Country:US
Practice Address - Phone:616-666-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor