Provider Demographics
NPI:1841345774
Name:LEAHY, BRIAN LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LAWRENCE
Last Name:LEAHY
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 1:107 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4940
Mailing Address - Country:US
Mailing Address - Phone:617-389-6951
Mailing Address - Fax:
Practice Address - Street 1:107 FERRY ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-4940
Practice Address - Country:US
Practice Address - Phone:617-389-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor