Provider Demographics
NPI:1871636951
Name:LESLIE, HOLLY M (DC)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:M
Last Name:LESLIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:M
Other - Last Name:BAHRENBURG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1825 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1100
Mailing Address - Country:US
Mailing Address - Phone:719-390-5008
Mailing Address - Fax:719-390-9321
Practice Address - Street 1:1825 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1100
Practice Address - Country:US
Practice Address - Phone:719-390-5008
Practice Address - Fax:719-390-9321
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800224Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER