Provider Demographics
NPI:1689753899
Name:MINER, LESLIE JEAN (DC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:JEAN
Last Name:MINER
Suffix:
Gender:F
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:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-0625
Mailing Address - Country:US
Mailing Address - Phone:817-481-7889
Mailing Address - Fax:817-481-1021
Practice Address - Street 1:115 E WORTH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5358
Practice Address - Country:US
Practice Address - Phone:817-481-7889
Practice Address - Fax:817-481-1021
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
605277Medicare ID - Type Unspecified
TXU58110Medicare UPIN