Provider Demographics
NPI:1194943175
Name:LEROY-LAWRENCE, MICHELLE A (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:LEROY-LAWRENCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:LEROY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:270 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9186
Mailing Address - Country:US
Mailing Address - Phone:770-591-9153
Mailing Address - Fax:
Practice Address - Street 1:2230 TOWNE LAKE PKWY
Practice Address - Street 2:BUILDING 100 SUITE 140
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5540
Practice Address - Country:US
Practice Address - Phone:770-591-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR003045111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBLGMedicare ID - Type Unspecified