Provider Demographics
NPI:1093837072
Name:LEONARD, MATTHEW BARTLETT I (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BARTLETT
Last Name:LEONARD
Suffix:I
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6244
Mailing Address - Country:US
Mailing Address - Phone:203-255-3800
Mailing Address - Fax:203-256-5975
Practice Address - Street 1:400 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6244
Practice Address - Country:US
Practice Address - Phone:203-255-3800
Practice Address - Fax:203-256-5975
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 000926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4112950Medicaid