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General NPI Number Information
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NPI Number | 1598197584
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Entity Type | Individual
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Provider Name | LESLIE KEVIN ETHRIDGE D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2013
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 124 FORD AVE
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City | NEWTON
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State | MS
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Zip | 39345-2222
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Country | US
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Telephone | 601-527-9707
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Fax |
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Provider Business Mailing Address
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Address Line | 124 FORD AVE
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City | NEWTON
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State | MS
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Zip | 39345-2222
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Country | US
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Telephone | 601-527-9707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1209
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 1209
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 1209
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 1209
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License Number State | MS
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Taxonomy #5
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | 1209
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License Number State | MS
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Taxonomy #6
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 1209
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License Number State | MS
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Taxonomy #7
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 1209
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License Number State | MS
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Taxonomy #8
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Taxonomy Code | 111NT0100X
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Taxonomy Name | Thermography Chiropractor
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License Number | 1209
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License Number State | MS
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Taxonomy #9
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Taxonomy Code | 111NX0100X
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Taxonomy Name | Occupational Health Chiropractor
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License Number | 1209
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License Number State | MS
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Taxonomy #10
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 1209
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License Number State | MS
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