Provider Demographics
NPI:1669772034
Name:LEADER, BRYAN ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ERIC
Last Name:LEADER
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 1:40 ELM ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2119
Mailing Address - Country:US
Mailing Address - Phone:315-730-8948
Mailing Address - Fax:
Practice Address - Street 1:2115 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-9435
Practice Address - Country:US
Practice Address - Phone:315-252-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX001207-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor