Provider Demographics
NPI:1982020772
Name:LECLERE, DANIEL ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:LECLERE
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 1:302 E MAPLE ST
Mailing Address - Street 2:P.O. BOX 357
Mailing Address - City:CENTRAL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52214-7732
Mailing Address - Country:US
Mailing Address - Phone:319-438-1089
Mailing Address - Fax:319-438-1091
Practice Address - Street 1:302 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:IA
Practice Address - Zip Code:52214-7732
Practice Address - Country:US
Practice Address - Phone:319-438-1089
Practice Address - Fax:319-438-1091
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor