Provider Demographics
NPI:1487794210
Name:LESLIE S. FEINBERG, DC, PC
Entity type:Organization
Organization Name:LESLIE S. FEINBERG, DC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-567-0200
Mailing Address - Street 1:633 E MAIN ST.
Mailing Address - Street 2:P.O. BOX 527
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-0527
Mailing Address - Country:US
Mailing Address - Phone:541-567-0200
Mailing Address - Fax:541-567-1176
Practice Address - Street 1:633 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1969
Practice Address - Country:US
Practice Address - Phone:541-567-0200
Practice Address - Fax:541-567-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67601Medicare UPIN
OR108965Medicare ID - Type Unspecified