Provider Demographics
NPI:1336497577
Name:BERNESKE, LESLIE LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:LEE
Last Name:BERNESKE
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 1:3661 TORRANCE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4886
Mailing Address - Country:US
Mailing Address - Phone:310-935-3005
Mailing Address - Fax:
Practice Address - Street 1:3661 TORRANCE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4886
Practice Address - Country:US
Practice Address - Phone:310-935-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor