Provider Demographics
NPI:1932267457
Name:LEER CHIROPRACTIC CENTER PSC
Entity Type:Organization
Organization Name:LEER CHIROPRACTIC CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-897-3001
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:LAOTTO
Mailing Address - State:IN
Mailing Address - Zip Code:46763-0218
Mailing Address - Country:US
Mailing Address - Phone:260-897-3001
Mailing Address - Fax:
Practice Address - Street 1:212 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAOTTO
Practice Address - State:IN
Practice Address - Zip Code:46763-0218
Practice Address - Country:US
Practice Address - Phone:260-897-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000066A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4542354OtherAETNA INS CO
IN581390Medicare PIN
INT34948Medicare UPIN