Provider Demographics
NPI:1285797720
Name:HICKEY, LESLIE GRACE (DC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:GRACE
Last Name:HICKEY
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 1:4300 S JOG RD UNIT 540611
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33454-5028
Mailing Address - Country:US
Mailing Address - Phone:561-603-3454
Mailing Address - Fax:561-616-8316
Practice Address - Street 1:550 OKEECHOBEE BLVD APT 811
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6333
Practice Address - Country:US
Practice Address - Phone:561-603-3454
Practice Address - Fax:561-616-8316
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor