Healthcare Provider Details

I. General information

NPI: 1619001336
Provider Name (Legal Business Name): LIVE OAK HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 GUILBEAU RD SUITE D
LAFAYETTE LA
70506-8709
US

IV. Provider business mailing address

620 GUILBEAU RD SUITE D
LAFAYETTE LA
70506-8709
US

V. Phone/Fax

Practice location:
  • Phone: 337-406-0644
  • Fax: 337-406-0656
Mailing address:
  • Phone: 337-406-0644
  • Fax: 337-406-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number448
License Number StateLA

VIII. Authorized Official

Name: DR. GAIL L LETTERLE
Title or Position: PRESIDENT
Credential: DC
Phone: 337-406-0644