Provider Demographics
NPI:1407746340
Name:GRIFALDO, LEONARDO R
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:R
Last Name:GRIFALDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 S GREAT SOUTHWEST PKWY STE 505
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3546
Mailing Address - Country:US
Mailing Address - Phone:972-647-2400
Mailing Address - Fax:972-647-2400
Practice Address - Street 1:2133 S GREAT SOUTHWEST PKWY STE 505
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3546
Practice Address - Country:US
Practice Address - Phone:972-647-2400
Practice Address - Fax:972-647-2400
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16454111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty