Provider Demographics
NPI:1295143055
Name:THOMAS J LEESEBERG
Entity type:Organization
Organization Name:THOMAS J LEESEBERG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEESEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-636-2251
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-0309
Mailing Address - Country:US
Mailing Address - Phone:701-636-2251
Mailing Address - Fax:701-636-2015
Practice Address - Street 1:102 1ST ST SW
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:ND
Practice Address - Zip Code:58045-4412
Practice Address - Country:US
Practice Address - Phone:701-636-2251
Practice Address - Fax:701-636-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty