Provider Demographics
NPI:1114180262
Name:LEJEUNE CHIROPRACTIC CLINC
Entity Type:Organization
Organization Name:LEJEUNE CHIROPRACTIC CLINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEJEUNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-989-4424
Mailing Address - Street 1:610 GUILBEAU RD
Mailing Address - Street 2:STE. A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-8707
Mailing Address - Country:US
Mailing Address - Phone:337-989-4424
Mailing Address - Fax:337-989-4435
Practice Address - Street 1:610 GUILBEAU RD
Practice Address - Street 2:STE. A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-8707
Practice Address - Country:US
Practice Address - Phone:337-989-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4394339190OtherBCBS LA
LA5X048Medicare PIN