Provider Demographics
NPI:1982926119
Name:LEIMBACK, DAN EDWARD
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:EDWARD
Last Name:LEIMBACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N WALSH DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-1941
Mailing Address - Country:US
Mailing Address - Phone:307-259-7991
Mailing Address - Fax:
Practice Address - Street 1:345 N WALSH DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-1941
Practice Address - Country:US
Practice Address - Phone:307-259-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator