Provider Demographics
NPI:1013586023
Name:LEAL, SERGIO ELIAS (DC)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:ELIAS
Last Name:LEAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W AVENUE C
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3035
Mailing Address - Country:US
Mailing Address - Phone:806-241-2134
Mailing Address - Fax:
Practice Address - Street 1:1106 W AMERICAN BLVD
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3145
Practice Address - Country:US
Practice Address - Phone:806-241-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor