1811213531 NPI number — JERRILYNN J. PRIMEAUX, D.C. (A PROFESSIONAL CHIROPRACTIC CORPORATION)

Table of content: (NPI 1811213531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811213531 NPI number — JERRILYNN J. PRIMEAUX, D.C. (A PROFESSIONAL CHIROPRACTIC CORPORATION)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERRILYNN J. PRIMEAUX, D.C. (A PROFESSIONAL CHIROPRACTIC CORPORATION)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED CHIROPRACTIC AND SPORTS REHABILITATION CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811213531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60082
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70596-0082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-504-4378
Provider Business Mailing Address Fax Number:
337-534-0041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 WESTMARK BLVD
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506-7370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-504-4378
Provider Business Practice Location Address Fax Number:
337-534-0041
Provider Enumeration Date:
04/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PRIMEAUX
Authorized Official First Name:
JERRILYNN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
337-306-0692

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1504 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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