Organization
LEIST, LTD.
Active
Other names
Performance Chiropractic and Sports Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK ALAN LEIST D.C. (PRESIDENT)
(314) 954-1885
Entity
Organization
Contact information
Practice address
104 N GRANT ST, OLNEY, IL 62450-2612
(618) 395-7246
(618) 395-7249
Mailing address
104 N GRANT ST, OLNEY, IL 62450-2612
(618) 395-7246
(618) 395-7249
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
IL038012269
IL
Other
Enumeration date
10/09/2012
Last updated
10/09/2012
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