Provider Demographics
NPI:1013084656
Name:LYNN, LESLIE ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANNE
Last Name:LYNN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANNE
Other - Last Name:SCHAEFER BRONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 DURBIN STATION CT STE 503
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-9370
Mailing Address - Country:US
Mailing Address - Phone:904-230-2343
Mailing Address - Fax:904-230-2352
Practice Address - Street 1:135 DURBIN STATION CT STE 503
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-9370
Practice Address - Country:US
Practice Address - Phone:904-230-2343
Practice Address - Fax:904-230-2352
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
70119OtherBCBS
70119Medicare UPIN
70119OtherBCBS