Provider Demographics
NPI:1851772040
Name:CORMIER, JEBADIAH (DC)
Entity Type:Individual
Prefix:DR
First Name:JEBADIAH
Middle Name:
Last Name:CORMIER
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 1:704 POINCIANA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2224
Mailing Address - Country:US
Mailing Address - Phone:337-468-3337
Mailing Address - Fax:
Practice Address - Street 1:704 POINCIANA AVE STE C
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2224
Practice Address - Country:US
Practice Address - Phone:337-468-3337
Practice Address - Fax:337-468-3422
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12921111N00000X
LA1830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor