Provider Demographics
NPI:1568568996
Name:LESSARD, CAROLE LOGUE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:LOGUE
Last Name:LESSARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790
Mailing Address - Country:US
Mailing Address - Phone:860-496-7246
Mailing Address - Fax:860-496-0553
Practice Address - Street 1:733 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790
Practice Address - Country:US
Practice Address - Phone:860-496-7246
Practice Address - Fax:860-496-0553
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1154111N00000X
FLCH8843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004164547Medicaid
U61842Medicare UPIN
350000955Medicare ID - Type Unspecified