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General NPI Number Information
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NPI Number | 1780908822
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Entity Type | Organization
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Legal Business Name | BEAU LEJEUNE DC PA
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 1332 BELT LINE RD STE A
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City | GARLAND
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State | TX
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Zip | 75040-3266
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Country | US
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Telephone | 972-496-9099
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Fax | 972-496-8910
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Provider Business Mailing Address
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Address Line | PO BOX 452215
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City | GARLAND
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State | TX
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Zip | 75045-2215
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Country | US
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Telephone | 972-496-9099
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Fax | 972-496-8910
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BEAU STACY LEJEUNE
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Credential | D.C.
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Telephone | 972-496-9099
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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 | 9177
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License Number State | TX
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