Provider Demographics
NPI:1457461618
Name:LEASK, STEPHANIE RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:RAE
Last Name:LEASK
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 1:1601 ESPLANADE
Mailing Address - Street 2:STE 5
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-893-3828
Mailing Address - Fax:530-332-9507
Practice Address - Street 1:1601 ESPLANADE
Practice Address - Street 2:STE 5
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-893-3828
Practice Address - Fax:530-332-9507
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0C0253460Medicare ID - Type Unspecified