Provider Demographics
NPI:1861762395
Name:LEBLANC, ANITA LOUISE (DC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:LOUISE
Last Name:LEBLANC
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 1:15 SW EVERETT MALL WAY STE G
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2715
Mailing Address - Country:US
Mailing Address - Phone:425-355-5222
Mailing Address - Fax:425-355-5231
Practice Address - Street 1:606 120TH AVE NE BUILDING D STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3024
Practice Address - Country:US
Practice Address - Phone:425-688-0223
Practice Address - Fax:425-688-0323
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60389093111N00000X
OR5022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor