Provider Demographics
NPI:1063654499
Name:LE, KIET A (DC)
Entity Type:Individual
Prefix:DR
First Name:KIET
Middle Name:A
Last Name:LE
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 1:2005 E KEARNEY ST STE F
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4606
Mailing Address - Country:US
Mailing Address - Phone:417-863-1166
Mailing Address - Fax:
Practice Address - Street 1:2005 E KEARNEY ST STE F
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4606
Practice Address - Country:US
Practice Address - Phone:417-863-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5836111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT93229Medicare UPIN