Provider Demographics
NPI:1699099564
Name:VANCE, LESLEY A (DC)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:A
Last Name:VANCE
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 1:11850 HESPERIA RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2173
Mailing Address - Country:US
Mailing Address - Phone:760-995-4500
Mailing Address - Fax:760-995-4501
Practice Address - Street 1:11850 HESPERIA RD
Practice Address - Street 2:SUITE 11
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-2173
Practice Address - Country:US
Practice Address - Phone:760-995-4500
Practice Address - Fax:760-995-4501
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1209111N00000X
CA32967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor