Provider Demographics
NPI:1568797959
Name:LEASE, VICKY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:VICKY
Middle Name:ANN
Last Name:LEASE
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 1:1116 S MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-9409
Mailing Address - Country:US
Mailing Address - Phone:270-526-6206
Mailing Address - Fax:270-526-6296
Practice Address - Street 1:1116 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-9409
Practice Address - Country:US
Practice Address - Phone:270-526-6206
Practice Address - Fax:270-526-6296
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100148660Medicaid
KY7100148660Medicaid
KYP100027900Medicare UPIN