Provider Demographics
NPI:1285674325
Name:PORCHE, BEAU ISAAC (DC)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:ISAAC
Last Name:PORCHE
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 1:430 CORPORATE DR.
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-873-8586
Mailing Address - Fax:985-873-8565
Practice Address - Street 1:430 CORPORATE DR.
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-873-8586
Practice Address - Fax:985-873-8565
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADC1380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor