=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164602470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD D LEONE CHIROPRACTIC CENTER, INC., P.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2007
-----------------------------------------------------
Last Update Date | 06/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1720 S 72ND ST SUITE 201
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98408-1245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-471-1287
-----------------------------------------------------
Fax | 253-471-1290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11009
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98508-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-471-1287
-----------------------------------------------------
Fax | 253-471-1290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | DR. RICHARD D. LEONE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 253-471-1287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00000775
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------