Provider Demographics
NPI:1538295639
Name:COHEN, LES (DC)
Entity Type:Individual
Prefix:DR
First Name:LES
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:BRUCE
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:15000 7TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3852
Mailing Address - Country:US
Mailing Address - Phone:760-952-3800
Mailing Address - Fax:760-245-9754
Practice Address - Street 1:15000 7TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3852
Practice Address - Country:US
Practice Address - Phone:760-952-3800
Practice Address - Fax:760-245-9754
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T18472Medicare UPIN