Provider Demographics
NPI:1255458550
Name:LENSGRAF, LEIF (D C)
Entity type:Individual
Prefix:
First Name:LEIF
Middle Name:
Last Name:LENSGRAF
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 E THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2737
Mailing Address - Country:US
Mailing Address - Phone:985-365-0001
Mailing Address - Fax:
Practice Address - Street 1:1004 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2737
Practice Address - Country:US
Practice Address - Phone:985-365-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA974OtherSTATE LICENSE
LA5T087Medicare ID - Type Unspecified
LA974OtherSTATE LICENSE