Provider Demographics
NPI:1831478494
Name:HEALTHSOURCE OF LELAND, PLLC
Entity Type:Organization
Organization Name:HEALTHSOURCE OF LELAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-392-5851
Mailing Address - Street 1:2013 OLDE REGENT WAY STE 130
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7285
Mailing Address - Country:US
Mailing Address - Phone:910-538-5507
Mailing Address - Fax:
Practice Address - Street 1:2013 OLDE REGENT WAY STE 130
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7285
Practice Address - Country:US
Practice Address - Phone:910-538-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty