Provider Demographics
NPI:1669537999
Name:LEUENBERGER, MARC (DC, DACS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:LEUENBERGER
Suffix:
Gender:M
Credentials:DC, DACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2308
Mailing Address - Country:US
Mailing Address - Phone:860-793-6824
Mailing Address - Fax:860-793-6824
Practice Address - Street 1:43 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2308
Practice Address - Country:US
Practice Address - Phone:860-793-6824
Practice Address - Fax:860-793-6824
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000729CT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000729CT01OtherANTHEM
CT000729CTOtherSTATE LICENSE
CT8949579OtherCIGNA
CTOR3039OtherLANDMARK
CT4296283OtherAETNA
CT754337OtherCONNECTICARE
CTT78358Medicare UPIN