# LEIST, LTD.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Performance Chiropractic and Sports Rehab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710239264
- **Authorized official:** DR. DEREK ALAN LEIST D.C. (PRESIDENT)
- **Authorized official phone:** (314) 954-1885

## Contact information

- **Practice address:** 104 N GRANT ST, OLNEY, IL 62450-2612
- **Practice address phone:** (618) 395-7246
- **Practice address fax:** (618) 395-7249
- **Mailing address:** 104 N GRANT ST, OLNEY, IL 62450-2612
- **Mailing address phone:** (618) 395-7246
- **Mailing address fax:** (618) 395-7249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | IL038012269 | IL | Yes |

## Other

- **Enumeration date:** 10/09/2012
- **Last updated:** 10/09/2012