Healthcare Provider Details

I. General information

NPI: 1801362751
Provider Name (Legal Business Name): LESLIE BATEMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 W UNION HILLS DR STE B100
GLENDALE AZ
85308-1313
US

IV. Provider business mailing address

5940 W UNION HILLS DR STE B100
GLENDALE AZ
85308-1313
US

V. Phone/Fax

Practice location:
  • Phone: 602-460-3490
  • Fax:
Mailing address:
  • Phone: 602-460-3490
  • Fax: 623-347-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9065
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number087991
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: