Provider Demographics
NPI:1013308196
Name:LESHAW, NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LESHAW
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 1:17651 1ST AVE S
Mailing Address - Street 2:STE 101
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2715
Mailing Address - Country:US
Mailing Address - Phone:425-369-1040
Mailing Address - Fax:
Practice Address - Street 1:1151 NW SAMMAMISH RD
Practice Address - Street 2:#101
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-369-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60534610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor