NPI Code Detail JSON Logo

1598197584 NPI number — LESLIE KEVIN ETHRIDGE D.C.

NPI Number: 1598197584
Health Care Provider/Practitioner: LESLIE KEVIN ETHRIDGE D.C.

Information about “1598197584” NPI (LESLIE KEVIN ETHRIDGE D.C.) exists in 1598197584 in HTML format HTML  |  1598197584 in plain Text format TXT  |  1598197584 in PDF (Portable Document Format) PDF  |  1598197584 in an XML format XML  formats.

NPI Number : 1598197584 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598197584",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ETHRIDGE",
    "FirstName": "LESLIE",
    "MiddleName": "KEVIN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "124 FORD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEWTON",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39345-2222",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "601-527-9707",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "124 FORD AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEWTON",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39345-2222",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-527-9707",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/01/2013",
    "LastUpdateDate": "08/01/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111NN0400X",
          "TaxonomyName": "Neurology Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "111NN1001X",
          "TaxonomyName": "Nutrition Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111NP0017X",
          "TaxonomyName": "Pediatric Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111NR0200X",
          "TaxonomyName": "Radiology Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111NR0400X",
          "TaxonomyName": "Rehabilitation Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111NS0005X",
          "TaxonomyName": "Sports Physician Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111NT0100X",
          "TaxonomyName": "Thermography Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111NX0100X",
          "TaxonomyName": "Occupational Health Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111NX0800X",
          "TaxonomyName": "Orthopedic Chiropractor",
          "LicenseNumber": "1209",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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