Provider Demographics
NPI:1295912418
Name:TERRENCE D LEIST LTD
Entity type:Organization
Organization Name:TERRENCE D LEIST LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:DARREL
Authorized Official - Last Name:LEIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-774-4916
Mailing Address - Street 1:1866 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-2842
Mailing Address - Country:US
Mailing Address - Phone:225-774-4916
Mailing Address - Fax:225-774-0460
Practice Address - Street 1:1866 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-2842
Practice Address - Country:US
Practice Address - Phone:225-774-4916
Practice Address - Fax:225-774-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA692938OtherAETNA
LA2285AOtherBLUE CROSS
LA692938OtherAETNA
LA59051Medicare PIN