Provider Demographics
NPI:1972746428
Name:PATRON, LELAND ISIP (DC)
Entity type:Individual
Prefix:DR
First Name:LELAND
Middle Name:ISIP
Last Name:PATRON
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 1:3231 RUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4224
Mailing Address - Country:US
Mailing Address - Phone:425-252-3127
Mailing Address - Fax:425-252-3128
Practice Address - Street 1:3231 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4224
Practice Address - Country:US
Practice Address - Phone:425-252-3127
Practice Address - Fax:425-252-3128
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60069990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor