Provider Demographics
NPI:1255564217
Name:LEON, BRENT JEREMY (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JEREMY
Last Name:LEON
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 1:606 E PLATT ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2415
Mailing Address - Country:US
Mailing Address - Phone:563-652-5687
Mailing Address - Fax:563-652-0281
Practice Address - Street 1:606 E PLATT ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2415
Practice Address - Country:US
Practice Address - Phone:563-652-5687
Practice Address - Fax:563-652-0281
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor