Provider Demographics
NPI:1184804056
Name:LEEPER CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:LEEPER CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEEPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-554-9637
Mailing Address - Street 1:229 S FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5702
Mailing Address - Country:US
Mailing Address - Phone:270-554-9637
Mailing Address - Fax:270-554-5337
Practice Address - Street 1:229 S FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5702
Practice Address - Country:US
Practice Address - Phone:270-554-9637
Practice Address - Fax:270-554-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000062868OtherANTHEM BLUE CROSS
KYU39425Medicare UPIN
KY000000062868OtherANTHEM BLUE CROSS
KY0645Medicare PIN