Provider Demographics
NPI:1043383029
Name:LEACH, WILLIAM T (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:LEACH
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 BROADWAY ST STE 208
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3654
Mailing Address - Country:US
Mailing Address - Phone:307-429-1089
Mailing Address - Fax:
Practice Address - Street 1:841 BROADWAY ST STE 208
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3654
Practice Address - Country:US
Practice Address - Phone:307-429-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26088111N00000X
WY829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26088Medicare ID - Type Unspecified