Provider Demographics
NPI:1134347214
Name:MERWIN, LESLIE MARK (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MARK
Last Name:MERWIN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15311 CANYON RD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-7473
Mailing Address - Country:US
Mailing Address - Phone:253-531-2745
Mailing Address - Fax:253-539-1815
Practice Address - Street 1:15311 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-7473
Practice Address - Country:US
Practice Address - Phone:253-531-2745
Practice Address - Fax:253-539-1815
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0017026OtherLABOR & INDUSTRIES