Provider Demographics
NPI:1306364377
Name:VALBRUN, LESLY (DC)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:VALBRUN
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 1:126 PARK AVENUE
Mailing Address - Street 2:UNIVERSITY OF BRIDGEPORT
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-7620
Mailing Address - Country:US
Mailing Address - Phone:203-576-4552
Mailing Address - Fax:
Practice Address - Street 1:51 NORTH ELM STREET
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1545
Practice Address - Country:US
Practice Address - Phone:203-574-4000
Practice Address - Fax:203-574-4003
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor