Provider Demographics
NPI:1912967340
Name:LODRIGUE, JOHN EDWARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:LODRIGUE
Suffix:JR
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 1:920 W KEISER AVE
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-2912
Mailing Address - Country:US
Mailing Address - Phone:870-563-3188
Mailing Address - Fax:870-563-5598
Practice Address - Street 1:920 W KEISER AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-2912
Practice Address - Country:US
Practice Address - Phone:870-563-3188
Practice Address - Fax:870-563-5598
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59753OtherARK BLUE CROSS PROV NUMBE
AR59753OtherARK BLUE CROSS PROV NUMBE