1477054211 NPI number — DR. MARINA LEONOVA DC

Table of content: DR. MARINA LEONOVA DC (NPI 1477054211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477054211 NPI number — DR. MARINA LEONOVA DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEONOVA
Provider First Name:
MARINA
Provider Middle Name:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477054211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700688
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78270-0688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-477-7654
Provider Business Mailing Address Fax Number:
210-468-0682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 HINKLE DR STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76201-1768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-404-6050
Provider Business Practice Location Address Fax Number:
866-313-3397
Provider Enumeration Date:
02/27/2018

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:  13747 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13747 . This is a "TEXAS BOARD OF CHIROPRACTIC EXAMINERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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