Provider Demographics
NPI:1659575488
Name:LAFAYETTE CHIROPRACTIC PHYSICIAN'S GROUP, INC
Entity Type:Organization
Organization Name:LAFAYETTE CHIROPRACTIC PHYSICIAN'S GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DUSTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-988-2188
Mailing Address - Street 1:207 RUE LOUIS XIV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5736
Mailing Address - Country:US
Mailing Address - Phone:337-988-2188
Mailing Address - Fax:337-988-2187
Practice Address - Street 1:207 RUE LOUIS XIV
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5736
Practice Address - Country:US
Practice Address - Phone:337-988-2188
Practice Address - Fax:337-988-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C495Medicare ID - Type UnspecifiedGROUP NUMBER