Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1869 | LA |
NPI | 1003461682 |
---|---|
Provider Name | Austin A Bouzigard |
First Address | Lockport, LA 70374-0117 |
Second Address | Lockport, LA 70374-2000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2019 |
Last Update Date | 09/08/2019 |