Provider Demographics
NPI:1447754049
Name:LEIBINGER, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:LEIBINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1207
Mailing Address - Country:US
Mailing Address - Phone:517-629-5505
Mailing Address - Fax:517-629-3805
Practice Address - Street 1:300 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1207
Practice Address - Country:US
Practice Address - Phone:517-629-5505
Practice Address - Fax:517-629-3805
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor