Provider Demographics
NPI:1043551989
Name:LOPEZ, LEONARD (DC)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:LOPEZ
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 1:3751 MAIN ST
Mailing Address - Street 2:# 600
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3751 MAIN ST
Practice Address - Street 2:# 600
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2808
Practice Address - Country:US
Practice Address - Phone:972-360-6408
Practice Address - Fax:972-360-6408
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6454111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner