Provider Demographics
NPI:1578521837
Name:LEAVELL, WENDY JANE (DC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JANE
Last Name:LEAVELL
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 1:2200 E 104TH AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:303-452-7308
Practice Address - Street 1:2200 E 104TH AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4404
Practice Address - Country:US
Practice Address - Phone:303-452-7300
Practice Address - Fax:303-452-7308
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor