Provider Demographics
NPI:1184684805
Name:LEBLANC, TROY J (DC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:J
Last Name:LEBLANC
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 1:1619 CARMEL AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-5300
Mailing Address - Country:US
Mailing Address - Phone:337-593-1144
Mailing Address - Fax:337-593-1155
Practice Address - Street 1:1619 CARMEL AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-5300
Practice Address - Country:US
Practice Address - Phone:337-593-1144
Practice Address - Fax:337-593-1155
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X803Medicare ID - Type Unspecified