Provider Demographics
NPI:1376088740
Name:HENDRICKS, LESLEY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:ANN
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LESLEY
Other - Middle Name:ANN
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2505 E PORTLAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1946
Mailing Address - Country:US
Mailing Address - Phone:971-412-2127
Mailing Address - Fax:503-339-9799
Practice Address - Street 1:2505 E PORTLAND RD STE 100
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1946
Practice Address - Country:US
Practice Address - Phone:971-412-2127
Practice Address - Fax:503-339-9799
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor