Provider Demographics
NPI:1326452608
Name:FABIAN, LEONARD WILLIAM III (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:WILLIAM
Last Name:FABIAN
Suffix:III
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 1:431 E HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-2058
Mailing Address - Country:US
Mailing Address - Phone:850-864-5300
Mailing Address - Fax:
Practice Address - Street 1:431 E HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-2058
Practice Address - Country:US
Practice Address - Phone:850-864-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor