Provider Demographics
NPI:1053589911
Name:LAVIGNE, LARRY (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:LAVIGNE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7103
Mailing Address - Country:US
Mailing Address - Phone:337-433-1919
Mailing Address - Fax:337-433-1928
Practice Address - Street 1:2121 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7103
Practice Address - Country:US
Practice Address - Phone:337-433-1919
Practice Address - Fax:337-433-1928
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053589911Medicare NSC