Provider Demographics
NPI:1851390538
Name:LEBLANC, PHILLIP KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:KEITH
Last Name:LEBLANC
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 1:425 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-1924
Mailing Address - Country:US
Mailing Address - Phone:409-833-3080
Mailing Address - Fax:409-833-9343
Practice Address - Street 1:425 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-1924
Practice Address - Country:US
Practice Address - Phone:409-833-3080
Practice Address - Fax:409-833-9343
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8297436002OtherCIGNA PROVIDER NUMBER
TX7619458OtherAETNA PROVIDER NUMBER
TX8H6010OtherBLUE CROSS/ BLUE SHIELD
TXU94236Medicare UPIN
TX609795Medicare ID - Type Unspecified