Provider Demographics
NPI:1063166437
Name:LE, NANCY P (DC)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:P
Last Name:LE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 BRYN MAWR AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2104
Mailing Address - Country:US
Mailing Address - Phone:717-327-7880
Mailing Address - Fax:
Practice Address - Street 1:5700 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2325
Practice Address - Country:US
Practice Address - Phone:215-709-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor