Provider Demographics
NPI:1144326240
Name:HEWITT, LESLIE (BS, DC, QME)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:BS, DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 BLACKHAWK PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4600
Mailing Address - Country:US
Mailing Address - Phone:925-736-3210
Mailing Address - Fax:925-736-3215
Practice Address - Street 1:3464 BLACKHAWK PLAZA CIR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4600
Practice Address - Country:US
Practice Address - Phone:925-736-3210
Practice Address - Fax:925-736-3215
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor