Provider Demographics
NPI:1760735393
Name:NATOLI-HENRY, LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:NATOLI-HENRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4658 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-4319
Mailing Address - Country:US
Mailing Address - Phone:808-430-1309
Mailing Address - Fax:
Practice Address - Street 1:1331 SAXON DR # 147
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-3160
Practice Address - Country:US
Practice Address - Phone:808-430-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor