Provider Demographics
NPI:1053553271
Name:DR. NECOLE LARUE CHIROPRACTOR INC.
Entity type:Organization
Organization Name:DR. NECOLE LARUE CHIROPRACTOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NECOLE
Authorized Official - Middle Name:LILLIAN
Authorized Official - Last Name:LARUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-643-7050
Mailing Address - Street 1:500 E WASHINGTON ST
Mailing Address - Street 2:UNIT 14
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-6301
Mailing Address - Country:US
Mailing Address - Phone:508-643-7050
Mailing Address - Fax:505-643-9619
Practice Address - Street 1:500 E WASHINGTON ST
Practice Address - Street 2:UNIT 14
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-6301
Practice Address - Country:US
Practice Address - Phone:508-643-7050
Practice Address - Fax:505-643-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20585541OtherAETNA
RI29065OtherBLUE CROSS BLUE SHIELD RI
RI401416OtherBLUE CROSS BLUE SHIELD RI BL;UE CHIP
MAY36507OtherBLUE CROSS BLUE SHIELD MA
MA1610732Medicaid
MAB20808501OtherCIGNA
MA4400505OtherUNITED HEALTH CARE
MA351208OtherHARVARD PILGRIM HEALTH CARE
MAY36507OtherBLUE CROSS BLUE SHIELD MA
RI401416OtherBLUE CROSS BLUE SHIELD RI BL;UE CHIP