Provider Demographics
NPI:1548435928
Name:LEGGE, JEREMY ARLEN (DC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ARLEN
Last Name:LEGGE
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 1:120 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1116
Mailing Address - Country:US
Mailing Address - Phone:812-537-5616
Mailing Address - Fax:
Practice Address - Street 1:120 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1116
Practice Address - Country:US
Practice Address - Phone:812-537-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
IN08002384A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200993030Medicare PIN