Provider Demographics
NPI:1982978458
Name:DUPRE, KACEY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KACEY
Middle Name:LYNN
Last Name:DUPRE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:LYNN
Other - Last Name:DESHOTELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 W TENNIS ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-4986
Mailing Address - Country:US
Mailing Address - Phone:337-381-0377
Mailing Address - Fax:337-381-0376
Practice Address - Street 1:417 W TENNIS ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-4986
Practice Address - Country:US
Practice Address - Phone:337-381-0377
Practice Address - Fax:337-381-0376
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor