Provider Demographics
NPI:1841360864
Name:LEEK, STEPHEN DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:LEEK
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 1:607 W OAK
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2537
Mailing Address - Country:US
Mailing Address - Phone:618-932-2137
Mailing Address - Fax:618-932-8815
Practice Address - Street 1:607 WEST OAK
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2537
Practice Address - Country:US
Practice Address - Phone:618-932-2137
Practice Address - Fax:618-932-8815
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL135117OtherHEALTHLINK
IL2882009OtherBLUE CROSS BLUE SHIELD
IL2882009OtherBLUE CROSS BLUE SHIELD
T37261Medicare UPIN