Provider Demographics
NPI:1053344028
Name:PICHE, LEA BARCLAY (DC)
Entity type:Individual
Prefix:MRS
First Name:LEA
Middle Name:BARCLAY
Last Name:PICHE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:LEA
Other - Middle Name:BARCLAY
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1832 OAK HOLLOW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-5918
Mailing Address - Country:US
Mailing Address - Phone:231-995-0990
Mailing Address - Fax:231-995-0991
Practice Address - Street 1:1832 OAK HOLLOW DR
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5918
Practice Address - Country:US
Practice Address - Phone:231-995-0990
Practice Address - Fax:231-995-0991
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI86560002Medicare ID - Type Unspecified
U77379Medicare UPIN