Provider Demographics
NPI:1811418692
Name:STEPHENS, LEAH MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MARIE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:VESTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:9920 PACIFIC HEIGHTS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4361
Mailing Address - Country:US
Mailing Address - Phone:515-803-1555
Mailing Address - Fax:
Practice Address - Street 1:9920 PACIFIC HEIGHTS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4361
Practice Address - Country:US
Practice Address - Phone:515-803-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor