Provider Demographics
NPI:1679640155
Name:LEATHERMAN, JEFFERY SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:SHAWN
Last Name:LEATHERMAN
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 1:431 E HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-2058
Mailing Address - Country:US
Mailing Address - Phone:850-864-5300
Mailing Address - Fax:850-864-3900
Practice Address - Street 1:431 E HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-2058
Practice Address - Country:US
Practice Address - Phone:850-864-5300
Practice Address - Fax:850-864-3900
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8740111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician