Provider Demographics
NPI:1982484176
Name:LEA UNLIMITED LLC
Entity Type:Organization
Organization Name:LEA UNLIMITED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:LEA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-322-7872
Mailing Address - Street 1:9240 N MERIDIAN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1876
Mailing Address - Country:US
Mailing Address - Phone:317-854-6116
Mailing Address - Fax:317-978-2964
Practice Address - Street 1:9240 N MERIDIAN ST STE 240
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1876
Practice Address - Country:US
Practice Address - Phone:317-854-6116
Practice Address - Fax:317-978-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty