Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1277 | LA |
NPI | 1376510768 |
---|---|
Provider Name | Dr. Jason P. Abshire |
First Address | Lafayette, LA 70503 |
Second Address | Lafayette, LA 70503-3060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 19/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U88811 | (02) | LA |