Provider Demographics
NPI:1760493456
Name:CUPON, LEANNE N (DC)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:N
Last Name:CUPON
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 1:3482 KEITH BRIDGE RD # 246
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5546
Mailing Address - Country:US
Mailing Address - Phone:770-740-1999
Mailing Address - Fax:
Practice Address - Street 1:3482 KEITH BRIDGE RD # 246
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5546
Practice Address - Country:US
Practice Address - Phone:770-740-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGGCMedicare ID - Type UnspecifiedMEDICARE #
GAU7877Medicare UPIN