Provider Demographics
NPI:1952484917
Name:LANCON, PAUL GREGORY (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GREGORY
Last Name:LANCON
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 1:1908 MAPLEWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663
Mailing Address - Country:US
Mailing Address - Phone:337-533-8750
Mailing Address - Fax:337-533-8752
Practice Address - Street 1:1908 MAPLEWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663
Practice Address - Country:US
Practice Address - Phone:337-533-8750
Practice Address - Fax:337-533-8752
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X083CE00Medicare ID - Type Unspecified
U63735Medicare UPIN