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General NPI Number Information
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NPI Number | 1275517047
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Entity Type | Individual
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Provider Name | TINA M THERIOT DC
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Gender | Female
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 612 RUE DE ONETTA
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City | NEW IBERIA
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State | LA
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Zip | 70563-2163
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Country | US
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Telephone | 337-367-6649
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Fax | 888-354-5793
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Provider Business Mailing Address
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Address Line | 612 RUE DE ONETTA
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City | NEW IBERIA
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State | LA
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Zip | 70563-2163
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Country | US
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Telephone | 337-367-6649
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Fax | 888-354-5793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1036
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License Number State | LA
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