Individual
DR. NICHOLAS ROGER LEROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1002 W. LAKE STREET, CHICAGO, IL 60607
(312) 243-3338
Mailing address
1002 W. LAKE STREET, CHICAGO, IL 60607
(312) 243-3338
Taxonomy
Speciality
Code
Description
License number
State
111NI0900X
Internist Chiropractor
Primary
038-007739
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001607135
BCBS
IL
01
—
457811
BLUE CROSS BLUE SHIELD
WI
Enumeration date
02/13/2007
Last updated
06/30/2010
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