Provider Demographics
NPI:1396817359
Name:CARROLL, LELAND EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:LELAND
Middle Name:EDWARD
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 RIVERSIDE DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1093
Mailing Address - Country:US
Mailing Address - Phone:818-760-4808
Mailing Address - Fax:818-760-4809
Practice Address - Street 1:11650 RIVERSIDE DR
Practice Address - Street 2:SUITE 8
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91602-1093
Practice Address - Country:US
Practice Address - Phone:818-760-4808
Practice Address - Fax:818-760-4809
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor