Provider Demographics
NPI:1861587164
Name:HUNTLEY, LEISHA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LEISHA
Middle Name:ANN
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 STATE ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722
Mailing Address - Country:US
Mailing Address - Phone:563-344-8785
Mailing Address - Fax:563-344-8785
Practice Address - Street 1:1530 STATE ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-344-8785
Practice Address - Fax:563-344-8785
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34728OtherWELLMARK-BCBS
IA34728OtherWELLMARK-BCBS