Provider Demographics
NPI:1407520950
Name:GALLIMORE, LEAH JANE (LAC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:JANE
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 OLD NC HIGHWAY 109
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-9406
Mailing Address - Country:US
Mailing Address - Phone:917-501-5636
Mailing Address - Fax:631-751-8298
Practice Address - Street 1:768 OLD NC HIGHWAY 109
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-9406
Practice Address - Country:US
Practice Address - Phone:917-501-5636
Practice Address - Fax:631-751-8298
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-2079171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist