Provider Demographics
NPI:1043655699
Name:LEITMAN, ERIC MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:LEITMAN
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 1:74 BARTON PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1778
Mailing Address - Country:US
Mailing Address - Phone:636-485-9972
Mailing Address - Fax:
Practice Address - Street 1:1960 S OLD HIGHWAY 94
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3727
Practice Address - Country:US
Practice Address - Phone:636-925-1919
Practice Address - Fax:636-435-6144
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013013332111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician