Provider Demographics
NPI:1740541960
Name:LESHER, JACOB THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:THOMAS
Last Name:LESHER
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 1:1565 THOMAS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2642
Mailing Address - Country:US
Mailing Address - Phone:651-734-6959
Mailing Address - Fax:
Practice Address - Street 1:1565 THOMAS CENTER DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2642
Practice Address - Country:US
Practice Address - Phone:651-734-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor