Provider Demographics
NPI:1114911583
Name:LEBON, GAYLE A (DC)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:A
Last Name:LEBON
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 1:5 GROGANS PARK DR
Mailing Address - Street 2:#103
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2189
Mailing Address - Country:US
Mailing Address - Phone:281-364-1496
Mailing Address - Fax:281-364-1489
Practice Address - Street 1:5 GROGANS PARK DR
Practice Address - Street 2:#103
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2189
Practice Address - Country:US
Practice Address - Phone:281-364-1496
Practice Address - Fax:281-364-1489
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603673OtherBC/BS
2045859OtherAETNA
U34705Medicare UPIN
603673Medicare ID - Type Unspecified