Provider Demographics
NPI:1811159056
Name:LEMOULLEC, ERIK GILLES (DC, FCAMI)
Entity type:Individual
Prefix:MR
First Name:ERIK
Middle Name:GILLES
Last Name:LEMOULLEC
Suffix:
Gender:M
Credentials:DC, FCAMI
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Mailing Address - Street 1:3 POMPERAUG OFFICE PARK
Mailing Address - Street 2:STE 103
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2287
Mailing Address - Country:US
Mailing Address - Phone:203-263-0411
Mailing Address - Fax:203-841-1012
Practice Address - Street 1:3 POMPERAUG OFFICE PARK STE 103
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2287
Practice Address - Country:US
Practice Address - Phone:203-263-0411
Practice Address - Fax:203-841-1012
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008043787Medicaid
CTD00000897OtherMEDICARE PROVIDER ID