Provider Demographics
NPI:1295877629
Name:POWERS, LEO ORVAL (DC)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:ORVAL
Last Name:POWERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LEO
Other - Middle Name:ORVAL
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:2585 POST ROAD
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-0872
Mailing Address - Country:US
Mailing Address - Phone:715-341-7102
Mailing Address - Fax:
Practice Address - Street 1:2585 POST ROAD
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-0872
Practice Address - Country:US
Practice Address - Phone:715-341-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38837100Medicaid
WI38837100Medicaid