Provider Demographics
NPI:1295929669
Name:ROBERT E LAVICTOIRE DC PC
Entity type:Organization
Organization Name:ROBERT E LAVICTOIRE DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LAVICTOIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-946-0148
Mailing Address - Street 1:818 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4204
Mailing Address - Country:US
Mailing Address - Phone:252-946-0148
Mailing Address - Fax:252-946-0148
Practice Address - Street 1:818 W 5TH STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889
Practice Address - Country:US
Practice Address - Phone:252-946-0148
Practice Address - Fax:252-946-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244499AOtherMEDICARE IND PTAN
NC8908551Medicaid
NC244499BOtherMEDICARE GROUP PTAN
08551OtherBLUE CROSS BLUE SHIELD
T244499Medicare UPIN
NC8908551Medicaid