Provider Demographics
NPI:1124228044
Name:JOHN E DAIGLE APMC
Entity Type:Organization
Organization Name:JOHN E DAIGLE APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-989-0800
Mailing Address - Street 1:345 DOUCET RD
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3488
Mailing Address - Country:US
Mailing Address - Phone:337-989-0800
Mailing Address - Fax:337-989-0867
Practice Address - Street 1:345 DOUCET RD
Practice Address - Street 2:SUITE 104B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3488
Practice Address - Country:US
Practice Address - Phone:337-989-0800
Practice Address - Fax:337-989-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56514CC61Medicare PIN