Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1835 | LA |
N | 111NI0013X | Independent Medical Examiner | 1835 | LA |
NPI | 1780175372 |
---|---|
Provider Name | Dr. Michael S Leblanc |
First Address | Lake Charles, LA 70605 |
Second Address | Lake Charles, LA 70605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2018 |
Last Update Date | 16/04/2019 |