Provider Demographics
NPI:1417386038
Name:CORMIER, COLEMAN JOSEPH (DC)
Entity Type:Individual
Prefix:MR
First Name:COLEMAN
Middle Name:JOSEPH
Last Name:CORMIER
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 1:6902 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-9999
Mailing Address - Country:US
Mailing Address - Phone:985-868-3136
Mailing Address - Fax:985-868-4040
Practice Address - Street 1:6902 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-9999
Practice Address - Country:US
Practice Address - Phone:985-868-3136
Practice Address - Fax:985-868-4040
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor