Provider Demographics
NPI:1194981597
Name:LEBLANC, KELLEY M (DC)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:M
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:M
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1000 WILLIAM HILTON PKWY
Mailing Address - Street 2:STE K100
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-6110
Mailing Address - Country:US
Mailing Address - Phone:843-321-8119
Mailing Address - Fax:404-448-4493
Practice Address - Street 1:1000 WILLIAM HILTON PKWY
Practice Address - Street 2:STE K100
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-6110
Practice Address - Country:US
Practice Address - Phone:843-321-8119
Practice Address - Fax:404-448-4493
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008370111N00000X
SC3695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor