Provider Demographics
NPI:1659428381
Name:MONTEITH, LEONARD KEIFFER (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:KEIFFER
Last Name:MONTEITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 STERLING ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2007
Mailing Address - Country:US
Mailing Address - Phone:404-688-2341
Mailing Address - Fax:404-633-7175
Practice Address - Street 1:1989 N WILLIAMSBURG DR
Practice Address - Street 2:SUITE D
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3509
Practice Address - Country:US
Practice Address - Phone:404-633-7175
Practice Address - Fax:404-633-7175
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35CGBVHMedicare ID - Type Unspecified