MEDICARE: DR. KIET A LE D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0013X	Independent Medical Examiner Chiropractor	5836	MO

General Provider Information

NPI Number	:	1063654499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIET A LE D.C

Provider Business Mailing Address
First Line	:	2005 E KEARNEY ST STE F
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-4606
Country	:	US
Telephone Number	:	417-863-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 E KEARNEY ST STE F
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-4606
Country	:	US
Telephone Number	:	417-863-1166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	03/31/2009

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