Provider Demographics
NPI:1174611016
Name:LESLIE HOLCOMBE D.C., P.C., T/A
Entity type:Organization
Organization Name:LESLIE HOLCOMBE D.C., P.C., T/A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-933-9000
Mailing Address - Street 1:4600 KING ST
Mailing Address - Street 2:SUITE 2L
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1277
Mailing Address - Country:US
Mailing Address - Phone:703-933-9000
Mailing Address - Fax:703-933-9166
Practice Address - Street 1:4600 KING ST
Practice Address - Street 2:SUITE 2L
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1277
Practice Address - Country:US
Practice Address - Phone:703-933-9000
Practice Address - Fax:703-933-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00A109J70Medicare ID - Type Unspecified
VAU83631Medicare UPIN