Provider Demographics
NPI:1225217805
Name:SMART, LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:SMART
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 1:115 N WAHSATCH AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3491
Mailing Address - Country:US
Mailing Address - Phone:719-520-5309
Mailing Address - Fax:719-520-1332
Practice Address - Street 1:115 N WAHSATCH AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3491
Practice Address - Country:US
Practice Address - Phone:719-520-5309
Practice Address - Fax:719-520-1332
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor