Provider Demographics
NPI:1295880847
Name:LEACH, VICTOR (DC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:LEACH
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 1:2520 SAINT ROSE PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7783
Mailing Address - Country:US
Mailing Address - Phone:702-579-9876
Mailing Address - Fax:702-579-9877
Practice Address - Street 1:2520 SAINT ROSE PKWY
Practice Address - Street 2:STE 101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7783
Practice Address - Country:US
Practice Address - Phone:702-579-9876
Practice Address - Fax:702-579-9877
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV103740Medicare UPIN