Provider Demographics
NPI:1629114509
Name:HART, LEO J (DC)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:J
Last Name:HART
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 SE DIXIE HWY STE 2
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3054
Mailing Address - Country:US
Mailing Address - Phone:772-288-6456
Mailing Address - Fax:772-288-4195
Practice Address - Street 1:500 SE DIXIE HWY STE 2
Practice Address - Street 2:SUITE 2
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3054
Practice Address - Country:US
Practice Address - Phone:772-288-6456
Practice Address - Fax:772-288-4195
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH0007783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033400OtherNEIGHBORHOOD HEALTH PLAN
FL53858OtherBLUE CROSS BLUE SHIELD
FL53858OtherBLUE CROSS BLUE SHIELD