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Individual

DR. HENRY L LEAVENGOOD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
1238 S HOUSTON LAKE RD, STE 3, WARNER ROBINS, GA 31088-0723
(478) 988-4663
(478) 988-4881
Mailing address
1238 S HOUSTON LAKE RD, STE 3, WARNER ROBINS, GA 31088-0723
(478) 988-4663
(478) 988-4881

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR002823
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
GRP6135
MEDICARE GROUP NUMBER
GA
Enumeration date
12/20/2006
Last updated
07/08/2007
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