Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC005259L | PA |
NPI | 1124029657 |
---|---|
Provider Name | Dr. Gilbert E. Leadbitter |
First Address | Monongahela, PA 15063-1034 |
Second Address | Monongahela, PA 15063-1034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U56649 | (02) | PA |