Provider Demographics
NPI:1417397159
Name:WEATHERSBY, LEON PATRICK JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:PATRICK
Last Name:WEATHERSBY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LEON
Other - Middle Name:
Other - Last Name:WEATHERSBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:8255 VINEYARD AVE
Mailing Address - Street 2:1100H
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3375
Mailing Address - Country:US
Mailing Address - Phone:310-838-1600
Mailing Address - Fax:310-453-1363
Practice Address - Street 1:9225 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3324
Practice Address - Country:US
Practice Address - Phone:310-838-1600
Practice Address - Fax:310-453-1363
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor