Provider Demographics
NPI:1982794053
Name:STARR-OMER, LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:STARR-OMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-4043
Mailing Address - Country:US
Mailing Address - Phone:812-254-0476
Mailing Address - Fax:812-254-0476
Practice Address - Street 1:501 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4043
Practice Address - Country:US
Practice Address - Phone:812-254-0476
Practice Address - Fax:812-254-0477
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200042620Medicaid
INP00462434OtherPALMETTO GBA- RAILROAL MEDICARE
INP00462434OtherPALMETTO GBA- RAILROAL MEDICARE