Healthcare Provider Details

I. General information

NPI: 1184684805
Provider Name (Legal Business Name): TROY J LEBLANC D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 CARMEL AVE
LAFAYETTE LA
70501-5300
US

IV. Provider business mailing address

1619 CARMEL AVE
LAFAYETTE LA
70501-5300
US

V. Phone/Fax

Practice location:
  • Phone: 337-593-1144
  • Fax: 337-593-1155
Mailing address:
  • Phone: 337-593-1144
  • Fax: 337-593-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1162
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: