Provider Demographics
NPI:1073575262
Name:HOLCOMBE, LESLIE (DC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HOLCOMBE
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 1:4600 KING ST
Mailing Address - Street 2:SUITE 2L
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1277
Mailing Address - Country:US
Mailing Address - Phone:703-933-9000
Mailing Address - Fax:703-933-9166
Practice Address - Street 1:4600 KING ST
Practice Address - Street 2:SUITE 2L
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1277
Practice Address - Country:US
Practice Address - Phone:703-933-9000
Practice Address - Fax:703-933-9166
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU83631Medicare UPIN
VA00A109J70Medicare ID - Type Unspecified