Provider Demographics
NPI:1356466510
Name:LUQUETTE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LUQUETTE CHIROPRACTIC PC
Other - Org Name:LUQUETTE CHIROPRACTIC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LUQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:936-569-0200
Mailing Address - Street 1:4619 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1816
Mailing Address - Country:US
Mailing Address - Phone:936-569-0200
Mailing Address - Fax:936-569-0262
Practice Address - Street 1:4619 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1816
Practice Address - Country:US
Practice Address - Phone:936-569-0200
Practice Address - Fax:936-569-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80020SOtherBCBS
TX80020SOtherBCBS
TXU52298Medicare UPIN