Provider Demographics
NPI:1659590016
Name:SHARP, LESLIE D (DC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:SHARP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2010
Mailing Address - Country:US
Mailing Address - Phone:817-573-6725
Mailing Address - Fax:
Practice Address - Street 1:504 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2010
Practice Address - Country:US
Practice Address - Phone:817-573-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600962OtherBLUE CROSS
TX600962OtherS'VILLE BC