Provider Demographics
NPI:1548318181
Name:LESUEUR, DARREL DON (DC)
Entity type:Individual
Prefix:DR
First Name:DARREL
Middle Name:DON
Last Name:LESUEUR
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 1:916 E BASELINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6600
Mailing Address - Country:US
Mailing Address - Phone:480-926-0088
Mailing Address - Fax:480-926-0025
Practice Address - Street 1:916 E BASELINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6600
Practice Address - Country:US
Practice Address - Phone:480-926-0088
Practice Address - Fax:480-926-0025
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0082420OtherBCBS
AZ1Z4633OtherHEALTHNET
AZAZ0082420OtherBCBS