Provider Demographics
NPI:1851534382
Name:PELLOQUIN, DUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:PELLOQUIN
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 1:1606A SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-5157
Mailing Address - Country:US
Mailing Address - Phone:337-298-0154
Mailing Address - Fax:337-432-5467
Practice Address - Street 1:1606A SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-5157
Practice Address - Country:US
Practice Address - Phone:337-298-0154
Practice Address - Fax:337-432-5467
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor