Provider Demographics
NPI:1023041878
Name:LEMIEUX, LARRY D (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:LEMIEUX
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 1:617 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS PT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2425
Mailing Address - Country:US
Mailing Address - Phone:609-926-3800
Mailing Address - Fax:609-926-3128
Practice Address - Street 1:617 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2425
Practice Address - Country:US
Practice Address - Phone:609-926-3800
Practice Address - Fax:609-926-3128
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0524483000OtherAMERIHEALTH HMO POS
NJ223110029OtherTIN
NJ223110029OtherTIN