Provider Demographics
NPI:1114049491
Name:LEDOUX, JAMES E SR (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:LEDOUX
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:676 ASHLEY FOREST DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-6378
Mailing Address - Country:US
Mailing Address - Phone:770-722-0346
Mailing Address - Fax:770-592-1191
Practice Address - Street 1:4290 BELLS FERRY RD NW
Practice Address - Street 2:SUITE 118
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7140
Practice Address - Country:US
Practice Address - Phone:770-722-0346
Practice Address - Fax:770-592-1191
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO05338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU56356Medicare UPIN
GA35ZCCZZMedicare ID - Type Unspecified