Provider Demographics
NPI:1952325433
Name:LECKRONE, MABLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MABLE
Middle Name:MARIE
Last Name:LECKRONE
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 1:401 SMILEY RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-7705
Mailing Address - Country:US
Mailing Address - Phone:816-781-8810
Mailing Address - Fax:816-781-3468
Practice Address - Street 1:257 W MILL ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2339
Practice Address - Country:US
Practice Address - Phone:816-781-8810
Practice Address - Fax:816-781-3468
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003838111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO06055021OtherBLUE CROSS/ BLUE SHIELD
MO06055021OtherBLUE CROSS/ BLUE SHIELD
T203356Medicare ID - Type Unspecified