Provider Demographics
NPI:1801645619
Name:LEBLANC, CORNEL DAVID
Entity type:Individual
Prefix:
First Name:CORNEL
Middle Name:DAVID
Last Name:LEBLANC
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 1:9180 TOWN SQUARE BLVD APT 1212
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-1369
Mailing Address - Country:US
Mailing Address - Phone:318-880-2085
Mailing Address - Fax:
Practice Address - Street 1:7701 I 40 W # 102B
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-0999
Practice Address - Country:US
Practice Address - Phone:806-410-3079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor