Healthcare Provider Details

I. General information

NPI: 1629439799
Provider Name (Legal Business Name): LESLIE SCOTT PACHTER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 GLADES RD STE 108
BOCA RATON FL
33434-3988
US

IV. Provider business mailing address

9325 GLADES RD STE 108
BOCA RATON FL
33434-3988
US

V. Phone/Fax

Practice location:
  • Phone: 561-477-8588
  • Fax: 561-488-0722
Mailing address:
  • Phone: 561-477-8588
  • Fax: 561-488-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8072729-1202
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH 6224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: