Provider Demographics
NPI:1740585181
Name:FULBRIGHT, LAKENDRA S (DC)
Entity Type:Individual
Prefix:DR
First Name:LAKENDRA
Middle Name:S
Last Name:FULBRIGHT
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 1:4863 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2232
Mailing Address - Country:US
Mailing Address - Phone:770-593-1916
Mailing Address - Fax:
Practice Address - Street 1:4863 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2232
Practice Address - Country:US
Practice Address - Phone:770-906-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-16
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor