Provider Demographics
NPI:1427133503
Name:LEIRO, JOSE A (DC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:LEIRO
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 1:10201 MASON AVE # AVE-16
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3306
Mailing Address - Country:US
Mailing Address - Phone:818-998-1532
Mailing Address - Fax:
Practice Address - Street 1:4778 PECK RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-1300
Practice Address - Country:US
Practice Address - Phone:626-350-3917
Practice Address - Fax:626-350-5259
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor