Provider Demographics
NPI:1457592180
Name:LEITH, JAY SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:SAMUEL
Last Name:LEITH
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 1:33 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3879
Mailing Address - Country:US
Mailing Address - Phone:781-934-0020
Mailing Address - Fax:781-934-0057
Practice Address - Street 1:33 RAILROAD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3879
Practice Address - Country:US
Practice Address - Phone:781-934-0020
Practice Address - Fax:781-934-0057
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor