Provider Demographics
NPI:1760505531
Name:ZACHARY ZANE LESLIE DC PA
Entity Type:Organization
Organization Name:ZACHARY ZANE LESLIE DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:ZANE
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-729-5051
Mailing Address - Street 1:100 WILLOW CREEK PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:903-729-5051
Mailing Address - Fax:903-729-0316
Practice Address - Street 1:100 WILLOW CREEK PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801
Practice Address - Country:US
Practice Address - Phone:903-729-5051
Practice Address - Fax:903-729-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty