Provider Demographics
NPI:1952323750
Name:SCHORK-BEVINS, LESLEE C (DC)
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:C
Last Name:SCHORK-BEVINS
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 1:505 W EMMITT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-1083
Mailing Address - Country:US
Mailing Address - Phone:740-941-4311
Mailing Address - Fax:740-947-9884
Practice Address - Street 1:505 W EMMITT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1083
Practice Address - Country:US
Practice Address - Phone:740-941-4311
Practice Address - Fax:740-947-9884
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098902Medicaid
OH2098902Medicaid
OHU73242Medicare UPIN