Provider Demographics
NPI:1508455783
Name:BUNN, LESLIE (L AC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BUNN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7053 LEE HWY STE 305
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1823
Mailing Address - Country:US
Mailing Address - Phone:423-521-0480
Mailing Address - Fax:
Practice Address - Street 1:7053 LEE HWY STE 305
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1823
Practice Address - Country:US
Practice Address - Phone:423-521-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN424171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist