Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2013013332 | MO |
NPI | 1043655699 |
---|---|
Provider Name | Eric Michael Leitman |
First Address | Saint Charles, MO 63301-1778 |
Second Address | Saint Charles, MO 63303-3727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 10/11/2021 |