Provider Demographics
NPI:1265514228
Name:LARUE, NECOLE (DC)
Entity type:Individual
Prefix:
First Name:NECOLE
Middle Name:
Last Name:LARUE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 EAST WASHINGTON ST
Mailing Address - Street 2:STE 14
Mailing Address - City:NOTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1134
Mailing Address - Country:US
Mailing Address - Phone:508-643-7050
Mailing Address - Fax:508-643-9619
Practice Address - Street 1:500 EAST WASHINGTON ST
Practice Address - Street 2:STE 14
Practice Address - City:NOTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1134
Practice Address - Country:US
Practice Address - Phone:508-643-7050
Practice Address - Fax:508-643-9619
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36507OtherBLUE CROSS
MA0610732Medicaid
MA351208OtherHARVARD PILGRIM
U66387Medicare UPIN
MAY36507OtherBLUE CROSS