Provider Demographics
NPI:1326845140
Name:LEIVA, LUCAS NICOLAS (DC)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:NICOLAS
Last Name:LEIVA
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E CHESTNUT AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5914
Mailing Address - Country:US
Mailing Address - Phone:916-207-8041
Mailing Address - Fax:
Practice Address - Street 1:3602 INLAND EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4900
Practice Address - Country:US
Practice Address - Phone:909-265-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor