Provider Demographics
NPI:1164761037
Name:COMEAUX, DANIEL C (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:COMEAUX
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 1:363 SLAY RD
Mailing Address - Street 2:
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465-6537
Mailing Address - Country:US
Mailing Address - Phone:318-623-8157
Mailing Address - Fax:
Practice Address - Street 1:1112 OLIVER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5714
Practice Address - Country:US
Practice Address - Phone:318-512-4951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA310089YUFVMedicare PIN