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NPI Code Detail

MEDICARE: J. PROVOST LLC (A PROFESSIONAL CHIROPRACTIC CORPORATION)

MEDICARE: J. PROVOST LLC (A PROFESSIONAL CHIROPRACTIC CORPORATION)
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor

General Provider Information

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

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Directions to “J. PROVOST LLC (A PROFESSIONAL CHIROPRACTIC CORPORATION) ” Practice Location

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