Provider Demographics
NPI:1881657336
Name:CORMIER, CHRISTOPHER J (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
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 1:2304 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6808
Mailing Address - Country:US
Mailing Address - Phone:337-456-6555
Mailing Address - Fax:337-706-7221
Practice Address - Street 1:2304 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6808
Practice Address - Country:US
Practice Address - Phone:337-456-6555
Practice Address - Fax:337-706-7221
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X727C495Medicare ID - Type Unspecified
LAU73809Medicare UPIN