Provider Demographics
NPI:1477861490
Name:LESLIE BUTTERWORTH, L.AC., PC
Entity Type:Organization
Organization Name:LESLIE BUTTERWORTH, L.AC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTERWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:210-862-8470
Mailing Address - Street 1:125 ODELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1647
Mailing Address - Country:US
Mailing Address - Phone:210-862-8470
Mailing Address - Fax:210-878-4297
Practice Address - Street 1:5282 MEDICAL DR STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6072
Practice Address - Country:US
Practice Address - Phone:210-862-8470
Practice Address - Fax:210-878-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00819171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty