Doctor Name: | DR. JERRY DALE LEECH |
NPI Number: | 1730517574 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 2013036906 |
Business Practice Address: | 2730 S Saint Peters Pkwy Suite 104 Saint Peters, MO - 633035677 |
Business Phone Number: | 6362445239 |
Business Fax Number: | 8882410474 |
Mailing Address: | 118 Brookside Ct, SAINT LOUIS |
State: | MO |
Postal Code: | 631465604 |
Phone Number: | 3149723107 |
Fax Number: | |
NPI Enumeration Date: | 10/14/2013 |
NPI Last Update Date: | 04/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 2013036906 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |