Provider Demographics
NPI:1972536894
Name:FREEMAN, LESLEY JO (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:JO
Last Name:FREEMAN
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 1:1518 WALNUT ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3419
Mailing Address - Country:US
Mailing Address - Phone:215-545-5117
Mailing Address - Fax:215-545-6687
Practice Address - Street 1:1518 WALNUT ST
Practice Address - Street 2:SUITE 303
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3419
Practice Address - Country:US
Practice Address - Phone:215-545-5117
Practice Address - Fax:215-545-6687
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074332Medicare ID - Type Unspecified