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General NPI Number Information
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NPI Number | 1598612376
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Entity Type | Organization
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Legal Business Name | J. PROVOST LLC (A PROFESSIONAL CHIROPRACTIC CORPORATION)
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 105 WESTMARK BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70506-7371
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Country | US
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Telephone | 337-993-2277
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 CEDARWOOD DR
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City | NEW IBERIA
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State | LA
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Zip | 70560-0415
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Country | US
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Telephone | 337-247-1513
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JILLIAN PROVOST
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Credential | DC
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Telephone | 337-247-1513
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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 |
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License Number State |
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