Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 902 | LA |
NPI | 1003195868 |
---|---|
Provider Name | Dr. Thomas Michael Dupont |
First Address | Lafayette, LA 70506-4263 |
Second Address | Lafayette, LA 70503-3243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2011 |
Last Update Date | 11/08/2011 |