Provider Demographics
NPI:1558575811
Name:KING, LESLIE MICHELLE (DC)
Entity Type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:MICHELLE
Last Name:KING
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 1:874 GLYNN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2167
Mailing Address - Country:US
Mailing Address - Phone:404-272-4872
Mailing Address - Fax:
Practice Address - Street 1:1862 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4163
Practice Address - Country:US
Practice Address - Phone:404-288-7559
Practice Address - Fax:404-288-1616
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor