NPIMap

Organization Active NPI

Leist, LTD.

  • Clinic/Center
  • Olney, IL
National Provider Identifier
1710239264
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
IL038012269 Issued in IL
Legal business name
LEIST, LTD.
Practice address
104 N Grant St
Olney, IL 62450-2612
Phone
(618) 395-7246
Fax
(618) 395-7249
NPI assigned
Oct 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Derek Alan Leist, D.C.NPI 1073836342
Title
President
Phone
(314) 954-1885

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X IL038012269 IL Primary

Addresses

Primary practice location

104 N Grant St
Olney, IL 62450-2612

Mailing address

104 N Grant St
Olney, IL 62450-2612
Phone (618) 395-7246

Other names 1

  • Performance Chiropractic and Sports Rehab Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349740800000",
    "number": "1710239264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 N GRANT ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502612",
            "telephone_number": "618-395-7246",
            "fax_number": "618-395-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N GRANT ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502612",
            "telephone_number": "618-395-7246",
            "fax_number": "618-395-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEIST, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-09",
        "last_updated": "2012-10-09",
        "status": "A",
        "authorized_official_last_name": "LEIST",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-954-1885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "IL038012269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Performance Chiropractic and Sports Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olney, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.