Organization
LIVING WELL CHIROPRACTIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY CLARENCE LEACH D.C. (CHIROPRACTOR)
(763) 230-7333
Entity
Organization
Contact information
Practice address
3140 HARBOR LN N STE 102, PLYMOUTH, MN 55447-5118
(763) 230-7333
(763) 230-7335
Mailing address
3140 HARBOR LN N STE 102, PLYMOUTH, MN 55447-5118
(763) 230-7333
(763) 230-7335
Taxonomy
Speciality
Code
Description
License number
State
111NI0013X
Independent Medical Examiner Chiropractor
Primary
111N00000X
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3500003067
MEDICARE
MN
Enumeration date
08/24/2010
Last updated
08/24/2010
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