Provider Demographics
NPI:1205987799
Name:LEBHAFT, DAVID MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:LEBHAFT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1808
Mailing Address - Country:US
Mailing Address - Phone:770-942-2396
Mailing Address - Fax:770-942-1788
Practice Address - Street 1:6602 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1808
Practice Address - Country:US
Practice Address - Phone:770-942-2396
Practice Address - Fax:770-942-1788
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGFPMedicare ID - Type Unspecified