MEDICARE: LUQUETTE CHIROPRACTIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6230	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80020S	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1356466510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUQUETTE CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	4619 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1816
Country	:	US
Telephone Number	:	936-569-0200
Fax Number	:	936-569-0262

Provider Business Practice Location Address
First Line	:	4619 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1816
Country	:	US
Telephone Number	:	936-569-0200
Fax Number	:	936-569-0262

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID ALLEN LUQUETTE
Credential	:	D.C.
Telephone Number	:	936-569-0200

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	11/21/2014

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