Provider Demographics
NPI:1780784777
Name:MAERHOFER, BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:MAERHOFER
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 1:540 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5528
Mailing Address - Country:US
Mailing Address - Phone:337-478-1186
Mailing Address - Fax:337-474-0640
Practice Address - Street 1:540 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5528
Practice Address - Country:US
Practice Address - Phone:337-478-1186
Practice Address - Fax:337-474-0640
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA59416Medicare ID - Type Unspecified