Provider Demographics
NPI:1720036643
Name:LEBOUEF, ERIC JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSEPH
Last Name:LEBOUEF
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 1:3115 COLLEGE PARK DR
Mailing Address - Street 2:106
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4000
Mailing Address - Country:US
Mailing Address - Phone:936-271-2555
Mailing Address - Fax:936-271-2557
Practice Address - Street 1:3115 COLLEGE PARK DR
Practice Address - Street 2:106
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4000
Practice Address - Country:US
Practice Address - Phone:936-271-2555
Practice Address - Fax:936-271-2557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU88647Medicare UPIN
TX8250B0Medicare ID - Type Unspecified