Provider Demographics
NPI:1225198625
Name:LETT, GARY L (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:LETT
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 1:1509 HARDY ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4906
Mailing Address - Country:US
Mailing Address - Phone:601-545-5388
Mailing Address - Fax:601-545-5389
Practice Address - Street 1:1509 HARDY ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4906
Practice Address - Country:US
Practice Address - Phone:601-545-5388
Practice Address - Fax:601-545-5389
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114944Medicaid
MS4433002OtherUNITED HEALTHCARE ID
MST20840Medicare UPIN