Provider Demographics
NPI:1467657619
Name:LEGAULT CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:LEGAULT CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:LEGAULT
Authorized Official - Last Name:VALCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-966-2211
Mailing Address - Street 1:5745 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6326
Mailing Address - Country:US
Mailing Address - Phone:954-966-2211
Mailing Address - Fax:
Practice Address - Street 1:5745 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6326
Practice Address - Country:US
Practice Address - Phone:954-966-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45822OtherBCBS GROUP #