Provider Demographics
NPI:1487682019
Name:DAIGLE, JOHN E (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:DAIGLE
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 1:345 DOUCET RD
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3488
Mailing Address - Country:US
Mailing Address - Phone:337-989-0800
Mailing Address - Fax:337-989-0867
Practice Address - Street 1:345 DOUCET RD
Practice Address - Street 2:SUITE 104B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3488
Practice Address - Country:US
Practice Address - Phone:337-989-0800
Practice Address - Fax:337-989-0867
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG7526OtherBLUE CROSS PROVIDER ID
LA5CC61Medicare ID - Type UnspecifiedPROVIDER ID