Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2301005142 | MI |
NPI | 1154382984 |
---|---|
Provider Name | Leonard J Leclair |
First Address | Standish, MI 48658-9550 |
Second Address | Standish, MI 48658-9550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 25/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1795778 | (05) | MI |
T82868 | (02) | MI |