Provider Demographics
NPI:1003653973
Name:LEONG WELLNESS INSTITUTE LLC
Entity type:Organization
Organization Name:LEONG WELLNESS INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-620-1965
Mailing Address - Street 1:4435 CONLETH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3736
Mailing Address - Country:US
Mailing Address - Phone:314-620-1965
Mailing Address - Fax:
Practice Address - Street 1:11750 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1804
Practice Address - Country:US
Practice Address - Phone:314-620-1965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty