Provider Demographics
NPI:1922269745
Name:CLEMENT, LESLIE M (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 YALE AVE E
Mailing Address - Street 2:STE 3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3336
Mailing Address - Country:US
Mailing Address - Phone:206-621-0984
Mailing Address - Fax:206-328-9319
Practice Address - Street 1:2349 YALE AVE E
Practice Address - Street 2:STE 3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3336
Practice Address - Country:US
Practice Address - Phone:206-621-0984
Practice Address - Fax:206-328-9319
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 2403111N00000X
WAMA 1919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA14141OtherWASHINGTON STATE LABOR AND INDUSTRIES
WAG 109797Medicare PIN