Provider Demographics
NPI:1104992452
Name:LEIB, ROBERT GEORGE JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEORGE
Last Name:LEIB
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:397 LITTLE NECK RD
Mailing Address - Street 2:3400 BUILDING, SUITE 108
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5765
Mailing Address - Country:US
Mailing Address - Phone:757-431-2225
Mailing Address - Fax:757-431-9314
Practice Address - Street 1:397 LITTLE NECK RD
Practice Address - Street 2:3400 BUILDING, SUITE 108
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5765
Practice Address - Country:US
Practice Address - Phone:757-431-2225
Practice Address - Fax:757-431-9314
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0104000871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350001273Medicare PIN
VAU34689Medicare UPIN
VASC0001057Medicare PIN