Provider Demographics
NPI:1558506824
Name:GAUTREAU, ROWDY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ROWDY
Middle Name:JAMES
Last Name:GAUTREAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3851
Mailing Address - Country:US
Mailing Address - Phone:337-988-2225
Mailing Address - Fax:337-988-0155
Practice Address - Street 1:3804 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3851
Practice Address - Country:US
Practice Address - Phone:337-988-2225
Practice Address - Fax:337-988-0155
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor