Healthcare Provider Details

I. General information

NPI: 1063064889
Provider Name (Legal Business Name): LESHAW CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17651 1ST AVE S STE 101
NORMANDY PARK WA
98148-2715
US

IV. Provider business mailing address

17651 1ST AVE S STE 101
NORMANDY PARK WA
98148-2715
US

V. Phone/Fax

Practice location:
  • Phone: 206-241-3836
  • Fax: 206-241-3967
Mailing address:
  • Phone: 206-241-3836
  • Fax: 206-241-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE LESHAW
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 206-241-3836