Provider Demographics
NPI:1841412756
Name:LEADER, DAVID ALAN (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:LEADER
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 1:1020 JAMES DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8832
Mailing Address - Country:US
Mailing Address - Phone:610-926-8805
Mailing Address - Fax:610-916-8318
Practice Address - Street 1:1020 JAMES DR
Practice Address - Street 2:SUITE103
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8832
Practice Address - Country:US
Practice Address - Phone:610-926-8805
Practice Address - Fax:610-916-8318
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006256L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALE812237Medicare PIN