Provider Demographics
NPI:1538231485
Name:LEACH, JASON PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:PAUL
Last Name:LEACH
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 1:489 NORTH HIGHWAY 287
Mailing Address - Street 2:SUITE #190
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8905
Mailing Address - Country:US
Mailing Address - Phone:303-604-2600
Mailing Address - Fax:303-604-6358
Practice Address - Street 1:489 NORTH HIGHWAY 287
Practice Address - Street 2:SUITE #190
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8905
Practice Address - Country:US
Practice Address - Phone:303-604-2600
Practice Address - Fax:303-604-6358
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC463938Medicare UPIN