Provider Demographics
NPI:1548283476
Name:CORMIER CHIROPRACTIC, L.L.C.
Entity type:Organization
Organization Name:CORMIER CHIROPRACTIC, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-237-5306
Mailing Address - Street 1:854 KALISTE SALOOM RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4210
Mailing Address - Country:US
Mailing Address - Phone:337-237-5306
Mailing Address - Fax:337-232-9304
Practice Address - Street 1:854 KALISTE SALOOM RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4210
Practice Address - Country:US
Practice Address - Phone:337-237-5306
Practice Address - Fax:337-232-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11356331OtherCAQH
LA4330233790OtherBLUE CROSS BLUE SHIELD OF
LA669530OtherACN GROUP
LA7729631OtherAETNA
LA669530OtherACN GROUP