Provider Demographics
NPI:1831213198
Name:LEESEBERG, THOMAS JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:LEESEBERG
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:P.O. BOX 309
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-0309
Mailing Address - Country:US
Mailing Address - Phone:701-636-2251
Mailing Address - Fax:
Practice Address - Street 1:102 1ST ST. S.W.
Practice Address - Street 2:SUITE 1
Practice Address - City:HILLSBORO
Practice Address - State:ND
Practice Address - Zip Code:58045-0309
Practice Address - Country:US
Practice Address - Phone:701-636-2251
Practice Address - Fax:701-636-2015
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1230111N00000X
ND860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15454Medicaid