Provider Demographics
NPI:1053300376
Name:LAUTERBACH-DAVIS, LESLIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:LAUTERBACH-DAVIS
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 1:7917 EMERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1120
Mailing Address - Country:US
Mailing Address - Phone:310-215-9061
Mailing Address - Fax:310-641-8194
Practice Address - Street 1:7917 EMERSON AVENUE
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:CA
Practice Address - Zip Code:90045-1120
Practice Address - Country:US
Practice Address - Phone:310-215-9061
Practice Address - Fax:310-641-8194
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0141230OtherBLUE SHIELD
4287097OtherAETNA
CADC14123Medicare PIN