Provider Demographics
NPI:1245676709
Name:LEAKE, KAYLEIGH NICOLE (DC, CSCS)
Entity type:Individual
Prefix:DR
First Name:KAYLEIGH
Middle Name:NICOLE
Last Name:LEAKE
Suffix:
Gender:F
Credentials:DC, CSCS
Other - Prefix:DR
Other - First Name:KAYLEIGH
Other - Middle Name:NICOLE
Other - Last Name:KNUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, CSCS
Mailing Address - Street 1:255 COLE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6414
Mailing Address - Country:US
Mailing Address - Phone:858-558-3111
Mailing Address - Fax:858-558-3641
Practice Address - Street 1:8950 VIA LA JOLLA DR
Practice Address - Street 2:SUITE B212
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-558-3111
Practice Address - Fax:858-558-3641
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor