Provider Demographics
NPI:1831189331
Name:LEBER, JENIFER DEWALD (DC)
Entity type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:DEWALD
Last Name:LEBER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5664
Mailing Address - Country:US
Mailing Address - Phone:570-322-1776
Mailing Address - Fax:570-322-1774
Practice Address - Street 1:3501 MONTLIMAR PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609
Practice Address - Country:US
Practice Address - Phone:251-445-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007206L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017404480002Medicaid
PA0017404480002Medicaid
PAU74188Medicare UPIN