Provider Demographics
NPI:1609331040
Name:LEPRETRE, KEGAN JUDE
Entity Type:Individual
Prefix:
First Name:KEGAN
Middle Name:JUDE
Last Name:LEPRETRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WATER ST APT 11201
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-5282
Mailing Address - Country:US
Mailing Address - Phone:318-780-8002
Mailing Address - Fax:
Practice Address - Street 1:9778 KATY FWY STE 325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1646
Practice Address - Country:US
Practice Address - Phone:713-461-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor