Provider Demographics
NPI:1164434478
Name:DUFRENE, BRYAN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JOHN
Last Name:DUFRENE
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 1:3742 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-3141
Mailing Address - Country:US
Mailing Address - Phone:985-537-7187
Mailing Address - Fax:985-537-7188
Practice Address - Street 1:3742 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-3141
Practice Address - Country:US
Practice Address - Phone:985-537-7187
Practice Address - Fax:985-537-7188
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA656111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2183AOtherPROVIDER
LA2183AOtherPROVIDER
LAT-20096Medicare UPIN
LA2183AOtherPROVIDER