Provider Demographics
NPI:1245319565
Name:LEER, RONALD W (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:W
Last Name:LEER
Suffix:
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:PO BOX 218
Mailing Address - Street 2:212 S MAIN ST
Mailing Address - City:LAOTTO
Mailing Address - State:IN
Mailing Address - Zip Code:46763-0218
Mailing Address - Country:US
Mailing Address - Phone:260-897-3001
Mailing Address - Fax:
Practice Address - Street 1:212 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAOTTO
Practice Address - State:IN
Practice Address - Zip Code:46763-0218
Practice Address - Country:US
Practice Address - Phone:260-897-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000568A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4542354OtherAETNA INS. CO.
IN581390AMedicare ID - Type Unspecified
4542354OtherAETNA INS. CO.