Provider Demographics
NPI:1548779150
Name:RYAN, LESLIE M (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:RYAN
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 1:717 BONNIE CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4123
Mailing Address - Country:US
Mailing Address - Phone:321-400-6282
Mailing Address - Fax:321-333-5335
Practice Address - Street 1:2074 MEADOWLANE AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4950
Practice Address - Country:US
Practice Address - Phone:321-400-6282
Practice Address - Fax:321-333-5335
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor