MEDICARE: LAFAYETTE CHIROPRACTIC PHYSICIAN'S GROUP, INC

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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1659575488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAFAYETTE CHIROPRACTIC PHYSICIAN'S GROUP, INC

Provider Business Mailing Address
First Line	:	207 RUE LOUIS XIV
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5736
Country	:	US
Telephone Number	:	337-988-2188
Fax Number	:	337-988-2187

Provider Business Practice Location Address
First Line	:	207 RUE LOUIS XIV
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5736
Country	:	US
Telephone Number	:	337-988-2188
Fax Number	:	337-988-2187

Authorized Official
Title or Position	:	INS ADMIN
Name	:	DUSTI GUIDRY
Credential	:
Telephone Number	:	337-988-2188

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	11/13/2012

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