Healthcare Provider Details

I. General information

NPI: 1932507696
Provider Name (Legal Business Name): LESLIE ZOOK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 CONGRESS AVE
GLENDALE OH
45246-4426
US

IV. Provider business mailing address

1125 CONGRESS AVE
GLENDALE OH
45246-4426
US

V. Phone/Fax

Practice location:
  • Phone: 513-771-1109
  • Fax: 513-771-1129
Mailing address:
  • Phone: 513-771-1109
  • Fax: 513-771-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4444
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: