Provider Demographics
NPI:1740685601
Name:CHISCHILLY, LEAH (LAC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:CHISCHILLY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 E RANCHO DEL ORO DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3894
Mailing Address - Country:US
Mailing Address - Phone:480-297-3462
Mailing Address - Fax:
Practice Address - Street 1:29834 N CAVE CREEK RD STE 142
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5837
Practice Address - Country:US
Practice Address - Phone:480-513-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ010752171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist