Provider Demographics
NPI:1730399817
Name:PRINS, LESLIE JULIAN (DC )
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JULIAN
Last Name:PRINS
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 1:2527 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3022
Mailing Address - Country:US
Mailing Address - Phone:510-521-0792
Mailing Address - Fax:
Practice Address - Street 1:2316 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4514
Practice Address - Country:US
Practice Address - Phone:510-769-6066
Practice Address - Fax:510-769-1092
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15636111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05861Medicare UPIN
CADC015636Medicare ID - Type Unspecified