Healthcare Provider Details

I. General information

NPI: 1760493456
Provider Name (Legal Business Name): LEANNE N CUPON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3482 KEITH BRIDGE RD # 246
CUMMING GA
30041-5546
US

IV. Provider business mailing address

3482 KEITH BRIDGE RD # 246
CUMMING GA
30041-5546
US

V. Phone/Fax

Practice location:
  • Phone: 770-740-1999
  • Fax:
Mailing address:
  • Phone: 770-740-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR006250
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: