Provider Demographics
NPI:1093879561
Name:LE, THERESA B (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:B
Last Name:LE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13141 CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1211
Mailing Address - Country:US
Mailing Address - Phone:714-643-9008
Mailing Address - Fax:714-603-8966
Practice Address - Street 1:13141 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1211
Practice Address - Country:US
Practice Address - Phone:714-643-9008
Practice Address - Fax:714-603-8966
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor