MEDICARE: DONALD EDGAR JOHN LEBLANC

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	CH12692	FL

General Provider Information

NPI Number	:	1982177721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD EDGAR JOHN LEBLANC

Provider Business Mailing Address
First Line	:	4626 AYRON TER
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-4010
Country	:	US
Telephone Number	:	480-747-2753
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 S MAIN AVE STE 315
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3934
Country	:	US
Telephone Number	:	727-477-4255
Fax Number	:

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

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	01/04/2019

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