Provider Demographics
NPI:1699892943
Name:LAVERONI, LESLIE LIANNE (DC)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:LIANNE
Last Name:LAVERONI
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 1:2121 NEWCASTLE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1870
Mailing Address - Country:US
Mailing Address - Phone:760-635-2528
Mailing Address - Fax:760-635-2524
Practice Address - Street 1:2121 NEWCASTLE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1870
Practice Address - Country:US
Practice Address - Phone:760-635-2528
Practice Address - Fax:760-635-2524
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25587Medicare ID - Type UnspecifiedCHIROPRACTOR