Provider Demographics
NPI:1932639879
Name:LE, AITAM TERESA (DC)
Entity Type:Individual
Prefix:
First Name:AITAM TERESA
Middle Name:
Last Name:LE
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 1:15870 SOUTHWEST FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4594
Mailing Address - Country:US
Mailing Address - Phone:281-265-1005
Mailing Address - Fax:
Practice Address - Street 1:15870 SOUTHWEST FWY STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4594
Practice Address - Country:US
Practice Address - Phone:281-265-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor