Provider Demographics
NPI:1669848602
Name:CHAISSON, DAMIEN
Entity Type:Individual
Prefix:
First Name:DAMIEN
Middle Name:
Last Name:CHAISSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 BERTRAND DR
Mailing Address - Street 2:SUITE D4
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-9107
Mailing Address - Country:US
Mailing Address - Phone:337-237-2225
Mailing Address - Fax:337-237-2226
Practice Address - Street 1:1304 BERTRAND DR
Practice Address - Street 2:SUITE D4
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-9107
Practice Address - Country:US
Practice Address - Phone:337-237-2225
Practice Address - Fax:337-237-2226
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor