Provider Demographics
NPI:1164602470
Name:RICHARD D LEONE CHIROPRACTIC CENTER, INC., P.S.
Entity Type:Organization
Organization Name:RICHARD D LEONE CHIROPRACTIC CENTER, INC., P.S.
Other - Org Name:NEW LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-471-1287
Mailing Address - Street 1:PO BOX 11009
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:253-471-1287
Mailing Address - Fax:253-471-1290
Practice Address - Street 1:1720 S 72ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1245
Practice Address - Country:US
Practice Address - Phone:253-471-1287
Practice Address - Fax:253-471-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA350022640OtherMEDICARE RR
WA7802LEOtherREGENCE RIDER
WA0204807OtherL&I
WAG001063100Medicare PIN
WA350022640OtherMEDICARE RR