Provider Demographics
NPI:1780810838
Name:LEGER, LIONEL JL (DC)
Entity type:Individual
Prefix:MR
First Name:LIONEL
Middle Name:JL
Last Name:LEGER
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 1:209 NE 95TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2745
Mailing Address - Country:US
Mailing Address - Phone:305-756-3940
Mailing Address - Fax:305-756-3970
Practice Address - Street 1:209 NE 95TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2745
Practice Address - Country:US
Practice Address - Phone:305-756-3940
Practice Address - Fax:305-756-3970
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001384200Medicaid