Provider Demographics
NPI:1104873538
Name:LEONE, RICHARD D (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:LEONE
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:PO BOX 11009
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:253-471-1287
Mailing Address - Fax:253-471-1290
Practice Address - Street 1:1720 S 72ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1245
Practice Address - Country:US
Practice Address - Phone:253-471-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA910992806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2010924Medicaid
WA7802LEOtherREGENCE
WA0226231OtherL&I
WA3500022640OtherMEDICARE RR
WA7802LEOtherREGENCE
WA3500022640OtherMEDICARE RR