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General NPI Number Information
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NPI Number | 1215128889
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Entity Type | Organization
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Legal Business Name | PHILLIP K. LEBLANC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 1595 CORNERSTONE CT STE A
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City | BEAUMONT
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State | TX
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Zip | 77706-3899
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Country | US
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Telephone | 409-833-3080
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Fax | 409-833-9343
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Provider Business Mailing Address
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Address Line | 1595 CORNERSTONE CT STE A
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City | BEAUMONT
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State | TX
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Zip | 77706-3899
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Country | US
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Telephone | 409-833-3080
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Fax | 409-833-9343
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILLIP KEITH LEBLANC
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Credential | D.C.
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Telephone | 409-833-3080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9459
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License Number State | TX
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