Provider Demographics
NPI:1831222926
Name:LEATHERBURY, CY ROLAND (DC)
Entity type:Individual
Prefix:DR
First Name:CY
Middle Name:ROLAND
Last Name:LEATHERBURY
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 1:5150 E YALE CIR
Mailing Address - Street 2:SUITE100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6917
Mailing Address - Country:US
Mailing Address - Phone:303-757-5150
Mailing Address - Fax:303-753-1800
Practice Address - Street 1:5150 E YALE CIR
Practice Address - Street 2:SUITE100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6917
Practice Address - Country:US
Practice Address - Phone:303-757-5150
Practice Address - Fax:303-753-1800
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC28463Medicare ID - Type Unspecified