Provider Demographics
NPI:1700892536
Name:MACKLIN, LESLIE JEANNETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JEANNETTE
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:JEANNETTE
Other - Last Name:MOSBEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:9325 CENTER LAKE DR
Mailing Address - Street 2:SUITE #150
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0770
Mailing Address - Country:US
Mailing Address - Phone:704-494-4250
Mailing Address - Fax:704-494-4256
Practice Address - Street 1:9325 CENTER LAKE DR
Practice Address - Street 2:SUITE #150
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0770
Practice Address - Country:US
Practice Address - Phone:704-494-4250
Practice Address - Fax:704-494-4256
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007772111N00000X
NC3690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V10910Medicare UPIN