Provider Demographics
NPI:1194583187
Name:LE, BRYANT TAO (DC)
Entity type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:TAO
Last Name:LE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:625 BEAVER RUIN RD NW STE C
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3407
Mailing Address - Country:US
Mailing Address - Phone:470-359-7118
Mailing Address - Fax:470-359-7121
Practice Address - Street 1:625 BEAVER RUIN RD NW STE C
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3407
Practice Address - Country:US
Practice Address - Phone:470-359-7118
Practice Address - Fax:470-359-7121
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor