Provider Demographics
NPI:1790783678
Name:LEFEBVRE, JAMES T (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:LEFEBVRE
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 1:20 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-2615
Mailing Address - Country:US
Mailing Address - Phone:518-237-9485
Mailing Address - Fax:518-237-4608
Practice Address - Street 1:20 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:NY
Practice Address - Zip Code:12188-2615
Practice Address - Country:US
Practice Address - Phone:518-237-9485
Practice Address - Fax:518-237-4608
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005784-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC05784-6OtherWORKERS' COMP
NYC05784-6OtherWORKERS' COMP
NYT86369Medicare UPIN