Provider Demographics
NPI:1356302376
Name:CHURCHILL, LESLIE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:LYNN
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:LYNN
Other - Last Name:MCGINNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:13911 GOLD CIR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2378
Mailing Address - Country:US
Mailing Address - Phone:402-933-7575
Mailing Address - Fax:402-933-2033
Practice Address - Street 1:13911 GOLD CIR
Practice Address - Street 2:SUITE 230
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2378
Practice Address - Country:US
Practice Address - Phone:402-933-7575
Practice Address - Fax:402-933-2033
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025277600Medicaid
NEV09286Medicare UPIN