Provider Demographics
NPI:1770715831
Name:LESUEUR, CARL GORDON II (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:GORDON
Last Name:LESUEUR
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 E DRAPER PKWY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9095
Mailing Address - Country:US
Mailing Address - Phone:801-553-9691
Mailing Address - Fax:801-571-4288
Practice Address - Street 1:1178 DRAPER PKWY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:801-553-9691
Practice Address - Fax:801-571-4288
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7416390-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor