Provider Demographics
NPI:1700931847
Name:LEONARD, WILLIAM S (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:LEONARD
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 1:69311 GOLDEN WEST DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92241-8707
Mailing Address - Country:US
Mailing Address - Phone:760-251-1282
Mailing Address - Fax:
Practice Address - Street 1:11625 PALM DR
Practice Address - Street 2:SUITE G
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3629
Practice Address - Country:US
Practice Address - Phone:760-251-3032
Practice Address - Fax:760-251-4703
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC8777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD8777Medicare ID - Type UnspecifiedDC LICENSE #