Provider Demographics
NPI:1417997131
Name:SEALES, LESA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:MARIE
Last Name:SEALES
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 1:849 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2112
Mailing Address - Country:US
Mailing Address - Phone:616-847-2727
Mailing Address - Fax:616-847-0098
Practice Address - Street 1:849 PARK AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2112
Practice Address - Country:US
Practice Address - Phone:616-847-2727
Practice Address - Fax:616-847-0098
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor