Provider Demographics
NPI:1881880797
Name:LEATH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LEATH CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:LEATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-867-1001
Mailing Address - Street 1:11125 HIGHWAY 70
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8421
Mailing Address - Country:US
Mailing Address - Phone:901-867-1001
Mailing Address - Fax:901-867-1661
Practice Address - Street 1:11125 HIGHWAY 70
Practice Address - Street 2:SUITE 106
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-8421
Practice Address - Country:US
Practice Address - Phone:901-867-1001
Practice Address - Fax:901-867-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty