1013084656 NPI number — DR. LESLIE ANNE LYNN DC

Table of content: DR. LESLIE ANNE LYNN DC (NPI 1013084656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013084656 NPI number — DR. LESLIE ANNE LYNN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNN
Provider First Name:
LESLIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHAEFER BRONSON
Provider Other First Name:
LESLIE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013084656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 DURBIN STATION CT STE 503
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JOHNS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32259-9370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-230-2343
Provider Business Practice Location Address Fax Number:
904-230-2352
Provider Enumeration Date:
11/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH8304 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 70119 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".