Healthcare Provider Details

I. General information

NPI: 1801102082
Provider Name (Legal Business Name): LESLIE B HAWKINS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SE 1ST ST
LOOGOOTEE IN
47553-1608
US

IV. Provider business mailing address

211 SE 1ST ST
LOOGOOTEE IN
47553-1608
US

V. Phone/Fax

Practice location:
  • Phone: 812-295-3346
  • Fax: 812-295-4259
Mailing address:
  • Phone: 812-295-3346
  • Fax: 812-295-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002538A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: