Provider Demographics
NPI:1013200500
Name:PELLETIER, LAURENT (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURENT
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17416 CALLA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5709
Mailing Address - Country:US
Mailing Address - Phone:214-837-0434
Mailing Address - Fax:
Practice Address - Street 1:2133 S GREAT SOUTHWEST PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-7417
Practice Address - Country:US
Practice Address - Phone:972-647-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor