Provider Demographics
NPI:1225195498
Name:REAUX, JOSEPH TED (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:TED
Last Name:REAUX
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 1:824 E HUTCHINSON AVE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3942
Mailing Address - Country:US
Mailing Address - Phone:337-788-2873
Mailing Address - Fax:337-788-2192
Practice Address - Street 1:824 E HUTCHINSON AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3942
Practice Address - Country:US
Practice Address - Phone:337-788-2873
Practice Address - Fax:337-788-2192
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU53173Medicare UPIN
LA5T588Medicare ID - Type Unspecified