Provider Demographics
NPI:1982698205
Name:WHITE, LESLIE BOYD (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BOYD
Last Name:WHITE
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 1:445 S 152ND ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1107
Mailing Address - Country:US
Mailing Address - Phone:206-246-5370
Mailing Address - Fax:206-246-4806
Practice Address - Street 1:445 S 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1107
Practice Address - Country:US
Practice Address - Phone:206-246-5370
Practice Address - Fax:206-246-4806
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0000759111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2964500Medicaid
WAT01901Medicare UPIN
WA000105817Medicare ID - Type UnspecifiedMEDICARE