MEDICARE: DR. LESLIE ANNE LYNN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH8304	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70119	OTHER		BCBS

General Provider Information

NPI Number	:	1013084656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ANNE LYNN DC

Provider Business Mailing Address
First Line	:	135 DURBIN STATION CT STE 503
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-9370
Country	:	US
Telephone Number	:	904-230-2343
Fax Number	:	904-230-2352

Provider Business Practice Location Address
First Line	:	135 DURBIN STATION CT STE 503
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-9370
Country	:	US
Telephone Number	:	904-230-2343
Fax Number	:	904-230-2352

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	03/24/2022

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