Provider Demographics
NPI:1841442860
Name:LIGHTFOOT CLINIC OF CHIROPRACTIC
Entity type:Organization
Organization Name:LIGHTFOOT CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-237-2225
Mailing Address - Street 1:1304 BERTRAND DR
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-9107
Mailing Address - Country:US
Mailing Address - Phone:337-237-2225
Mailing Address - Fax:337-237-2226
Practice Address - Street 1:1304 BERTRAND DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-9107
Practice Address - Country:US
Practice Address - Phone:337-237-2225
Practice Address - Fax:337-237-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAV06289Medicare UPIN
LA5CR22Medicare PIN