Provider Demographics
NPI:1861593469
Name:LAVICTOIRE, ROBERT E (CH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:LAVICTOIRE
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4204
Mailing Address - Country:US
Mailing Address - Phone:252-946-0148
Mailing Address - Fax:252-946-0148
Practice Address - Street 1:818 W 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4204
Practice Address - Country:US
Practice Address - Phone:252-946-0148
Practice Address - Fax:252-946-0148
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-08551Medicaid
08551OtherBLUE CROSS BLUE SHIELD
T244499Medicare UPIN
NC89-08551Medicaid