Provider Demographics
NPI:1659587830
Name:LESLIE D. SHARP DC
Entity Type:Organization
Organization Name:LESLIE D. SHARP DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-968-5611
Mailing Address - Street 1:2287 N W LOOP
Mailing Address - Street 2:P O BOX 1336
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401
Mailing Address - Country:US
Mailing Address - Phone:254-968-5611
Mailing Address - Fax:
Practice Address - Street 1:2287 N W LOOP
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401
Practice Address - Country:US
Practice Address - Phone:254-968-5611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600962OtherS'VILLE BC 3
TX600962Medicare PIN