Provider Demographics
NPI:1518195304
Name:LELAND, NICOLE LYNN (DC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN
Last Name:LELAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:DEMOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:131 W EL PORTAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4633
Mailing Address - Country:US
Mailing Address - Phone:949-492-5511
Mailing Address - Fax:949-325-0036
Practice Address - Street 1:131 W EL PORTAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4633
Practice Address - Country:US
Practice Address - Phone:949-492-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor