Provider Demographics
NPI:1871135095
Name:LEONE, MILLICENT (DC)
Entity type:Individual
Prefix:DR
First Name:MILLICENT
Middle Name:
Last Name:LEONE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 DAKOTA AVE SE
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-2630
Mailing Address - Country:US
Mailing Address - Phone:760-421-7696
Mailing Address - Fax:
Practice Address - Street 1:128 DAKOTA AVE SE
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-2630
Practice Address - Country:US
Practice Address - Phone:760-421-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor