Provider Demographics
NPI:1053883793
Name:DAVIS, LESLIE ANNE (DC)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:ANNE
Other - Last Name:WARWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7153 N SPURWING RIM PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4003
Mailing Address - Country:US
Mailing Address - Phone:208-861-6327
Mailing Address - Fax:
Practice Address - Street 1:1326 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1703
Practice Address - Country:US
Practice Address - Phone:208-861-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor