Provider Demographics
NPI:1871642462
Name:SAMUELS, LEAH RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:RENEE
Last Name:SAMUELS
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 1:440 PELLIS RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4529
Mailing Address - Country:US
Mailing Address - Phone:724-834-5600
Mailing Address - Fax:724-834-5700
Practice Address - Street 1:440 PELLIS RD
Practice Address - Street 2:SUITE #7
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4529
Practice Address - Country:US
Practice Address - Phone:724-834-5600
Practice Address - Fax:724-834-5700
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015569220001Medicaid
PAV08712Medicare UPIN
PA099569SBRMedicare ID - Type Unspecified