Provider Demographics
NPI:1689751232
Name:LEVESQUE, ERIC JACQUES (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JACQUES
Last Name:LEVESQUE
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 1:1426 BEMIDJI AVE N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3856
Mailing Address - Country:US
Mailing Address - Phone:218-333-8811
Mailing Address - Fax:218-333-8813
Practice Address - Street 1:1426 BEMIDJI AVENUE NORTH
Practice Address - Street 2:SUITE 2
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-333-8811
Practice Address - Fax:218-333-8813
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5048111N00000X
MN5201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor