Provider Demographics
NPI:1811901853
Name:CORMIER, RONALD KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KEITH
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 1:3823 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6021
Mailing Address - Country:US
Mailing Address - Phone:337-237-5306
Mailing Address - Fax:337-552-2044
Practice Address - Street 1:3823 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6021
Practice Address - Country:US
Practice Address - Phone:337-237-5306
Practice Address - Fax:337-552-2044
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA669530OtherACN GROUP
LA7729631OtherAETNA
LA11356331OtherCAQH
LA4H229CX16Medicare PIN