Provider Demographics
NPI:1043210859
Name:LEVINE, LESTER NEIL (DC)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:NEIL
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 E NORMANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8484
Mailing Address - Country:US
Mailing Address - Phone:386-574-1464
Mailing Address - Fax:386-574-4895
Practice Address - Street 1:1240 E NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8484
Practice Address - Country:US
Practice Address - Phone:386-574-1464
Practice Address - Fax:386-574-4895
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050455600Medicaid
FL97413OtherBCBS
FL89762ZMedicare ID - Type Unspecified
FLT56332Medicare UPIN