Provider Demographics
NPI:1194030569
Name:LEVESQUE, WILLIE J (PA-C, DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:J
Last Name:LEVESQUE
Suffix:
Gender:M
Credentials:PA-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1011
Mailing Address - Country:US
Mailing Address - Phone:617-594-9372
Mailing Address - Fax:
Practice Address - Street 1:852 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1011
Practice Address - Country:US
Practice Address - Phone:617-594-9372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001849111N00000X
CT3056363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No111N00000XChiropractic ProvidersChiropractor