Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIR007959 | GA |
N | 111NP0017X | Pediatric Chiropractor | CHIR007959 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | CHIR007959 | GA |
Y | 111NS0005X | Chiropractic Sports Physician | CHIR007959 | GA |
NPI | 1023396561 |
---|---|
Provider Name | Dr. Eric Legault |
First Address | Mcdonough, GA 30253-5991 |
Second Address | Newnan, GA 30263-5802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2011 |
Last Update Date | 13/04/2012 |