Provider Demographics
NPI:1356618532
Name:LELBACH, JUSTIN THOMAS (LMP)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:THOMAS
Last Name:LELBACH
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 E WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-5966
Mailing Address - Country:US
Mailing Address - Phone:509-270-2387
Mailing Address - Fax:
Practice Address - Street 1:2408 E WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-5966
Practice Address - Country:US
Practice Address - Phone:509-270-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60197157174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist