Provider Demographics
NPI:1093116451
Name:DESHOTEL, KALEB (DC)
Entity Type:Individual
Prefix:DR
First Name:KALEB
Middle Name:
Last Name:DESHOTEL
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 1:2626 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5912
Mailing Address - Country:US
Mailing Address - Phone:337-990-5497
Mailing Address - Fax:337-990-5570
Practice Address - Street 1:2626 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5912
Practice Address - Country:US
Practice Address - Phone:337-990-5497
Practice Address - Fax:337-990-5570
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor