Provider Demographics
NPI:1063499457
Name:LESLIE, ROBERT JAMES (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:LESLIE
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 1:128 E PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8000
Mailing Address - Country:US
Mailing Address - Phone:704-663-3777
Mailing Address - Fax:704-664-6615
Practice Address - Street 1:128 E PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-8000
Practice Address - Country:US
Practice Address - Phone:704-663-3777
Practice Address - Fax:704-664-6615
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900961Medicaid
NC8908587Medicaid
NC8908587Medicaid