Provider Demographics
NPI:1184739070
Name:LEADER, ERIC T (DC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:LEADER
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 1:2115 WEST GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021
Mailing Address - Country:US
Mailing Address - Phone:315-252-5789
Mailing Address - Fax:315-252-3113
Practice Address - Street 1:2115 WEST GENESEE STREET
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021
Practice Address - Country:US
Practice Address - Phone:315-252-5789
Practice Address - Fax:315-252-3113
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0073341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
54249CMedicare UPIN