Provider Demographics
NPI:1215196571
Name:SCOTT P DEROUEN DC PC
Entity Type:Organization
Organization Name:SCOTT P DEROUEN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEROUEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-502-5303
Mailing Address - Street 1:PO BOX 2146
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-2146
Mailing Address - Country:US
Mailing Address - Phone:337-502-5303
Mailing Address - Fax:337-479-2391
Practice Address - Street 1:1210 E MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4756
Practice Address - Country:US
Practice Address - Phone:337-502-5303
Practice Address - Fax:337-479-2391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA350052049OtherRAILROAD MEDICARE
LA5T852Medicare PIN
LA350052049OtherRAILROAD MEDICARE