Provider Demographics
NPI:1851485775
Name:LE, KEVIN T (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:LE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4935 JIMMY CARTER BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3536
Mailing Address - Country:US
Mailing Address - Phone:470-545-0275
Mailing Address - Fax:402-884-3349
Practice Address - Street 1:4935 JIMMY CARTER BLVD STE 360
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3536
Practice Address - Country:US
Practice Address - Phone:470-545-0275
Practice Address - Fax:470-246-5961
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009736111N00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025399400Medicaid
NE278886Medicare ID - Type Unspecified
NE10025399400Medicaid