Provider Demographics
NPI:1093007031
Name:SAMALOT, LEONARDO (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:SAMALOT
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 1:933 N WOODLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2734
Mailing Address - Country:US
Mailing Address - Phone:407-539-4772
Mailing Address - Fax:703-763-7272
Practice Address - Street 1:933 N WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2734
Practice Address - Country:US
Practice Address - Phone:075-394-7724
Practice Address - Fax:703-763-7272
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10840127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor