Provider Demographics
NPI:1902136468
Name:LOO, LEONARD C (DC)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:C
Last Name:LOO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LEONARD
Other - Middle Name:C
Other - Last Name:LOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1611 E CAPITOL EXPY STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1824
Mailing Address - Country:US
Mailing Address - Phone:408-223-1508
Mailing Address - Fax:408-223-7032
Practice Address - Street 1:1611 E CAPITOL EXPY STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1824
Practice Address - Country:US
Practice Address - Phone:408-223-1508
Practice Address - Fax:408-223-7032
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor