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NPI Code Detail

MEDICARE: SCOTT P DEROUEN DC

MEDICARE: SCOTT P DEROUEN DC
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
1111N00000XChiropractor1050LA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1350052044OTHERLARAILROAD MEDICARE

General Provider Information

NPI Number : 1720062177
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT P DEROUEN DC
Provider Business Mailing Address
First Line : 1210 E MCNEESE ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70607-4756
Country : US
Telephone Number : 337-502-5303
Fax Number : 337-479-2391
Provider Business Practice Location Address
First Line : 1210 E MCNEESE ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70607-4756
Country : US
Telephone Number : 337-502-5303
Fax Number : 337-479-2391
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 04/14/2010

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Directions to “ SCOTT P DEROUEN DC” Practice Location

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