Provider Demographics
NPI:1982177721
Name:LEBLANC, DONALD EDGAR JOHN
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:EDGAR JOHN
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 AYRON TER
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-4010
Mailing Address - Country:US
Mailing Address - Phone:480-747-2753
Mailing Address - Fax:
Practice Address - Street 1:51 S MAIN AVE STE 315
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3934
Practice Address - Country:US
Practice Address - Phone:727-477-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor