Provider Demographics
NPI:1962995563
Name:LEVESQUE, LEO A III (DC)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:A
Last Name:LEVESQUE
Suffix:III
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 1:2625 BUTTERFIELD RD STE 301N
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1266
Mailing Address - Country:US
Mailing Address - Phone:630-468-1824
Mailing Address - Fax:
Practice Address - Street 1:CHIRO ONE WELLNESS CENTER OF HALES CORNERS LLC
Practice Address - Street 2:5305 S 108TH ST
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130
Practice Address - Country:US
Practice Address - Phone:414-235-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009952111N00000X
WI5401-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty