Provider Demographics
NPI:1598780264
Name:KNIGHT, LESLY SCOT (CHIROPRACTIC DC)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:SCOT
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:CHIROPRACTIC DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N MAYS ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664
Mailing Address - Country:US
Mailing Address - Phone:512-388-7246
Mailing Address - Fax:512-671-3050
Practice Address - Street 1:307 N MAYS ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664
Practice Address - Country:US
Practice Address - Phone:512-388-7246
Practice Address - Fax:512-671-3050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605842OtherBCBS
48915Medicare UPIN
TX609089Medicare ID - Type Unspecified
TX606089Medicare PIN