Provider Demographics
NPI:1770685745
Name:KOONS, LEA R (DC)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:R
Last Name:KOONS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LEA
Other - Middle Name:R
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4510 CHARLESTOWN RD STE 700
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-8517
Mailing Address - Country:US
Mailing Address - Phone:812-944-4455
Mailing Address - Fax:812-944-4457
Practice Address - Street 1:4510 CHARLESTOWN RD STE 700
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-8517
Practice Address - Country:US
Practice Address - Phone:812-944-4455
Practice Address - Fax:812-944-4457
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001862A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000383006OtherANTHEM BCBS
IN000000383006OtherANTHEM BCBS