Provider Demographics
NPI:1063657435
Name:MERRITT, LESLIE MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MICHELLE
Last Name:MERRITT
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 1:100460 OVERSEAS HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2547
Mailing Address - Country:US
Mailing Address - Phone:303-588-1202
Mailing Address - Fax:
Practice Address - Street 1:100460 OVERSEAS HWY STE 4
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2547
Practice Address - Country:US
Practice Address - Phone:303-588-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9847111N00000X
CO6314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor