Provider Demographics
NPI:1710176987
Name:LEVERETTE, NICHOLAS EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:EUGENE
Last Name:LEVERETTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1890 STAR SHOOT PKWY STE 190
Mailing Address - Street 2:#773502
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4569
Mailing Address - Country:US
Mailing Address - Phone:859-263-2774
Mailing Address - Fax:859-263-2787
Practice Address - Street 1:1890 STAR SHOOT PKWY
Practice Address - Street 2:SUITE #190
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4512
Practice Address - Country:US
Practice Address - Phone:859-263-2774
Practice Address - Fax:859-263-2787
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10754111N00000X
KY5163111N00000X
KY249746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100083070Medicaid