Individual
DR. LESLIE KEVIN ETHRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
124 FORD AVE, NEWTON, MS 39345-2222
(601) 527-9707
Mailing address
124 FORD AVE, NEWTON, MS 39345-2222
(601) 527-9707
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1209
MS
111NN0400X
Neurology Chiropractor
Primary
1209
MS
111NN1001X
Nutrition Chiropractor
1209
MS
111NP0017X
Pediatric Chiropractor
1209
MS
111NR0200X
Radiology Chiropractor
1209
MS
111NR0400X
Rehabilitation Chiropractor
1209
MS
111NS0005X
Sports Physician Chiropractor
1209
MS
111NT0100X
Thermography Chiropractor
1209
MS
111NX0100X
Occupational Health Chiropractor
1209
MS
111NX0800X
Orthopedic Chiropractor
1209
MS
Other
Enumeration date
08/01/2013
Last updated
08/01/2013
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