Patrick W. Bourque, D.C.
Individual provider Active NPI Chiropractor · Prairieville, LA
NPI 1104939271 · NPPES record last updated May 7, 2009
Key facts
- NPI
- 1104939271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 1108 (LA)
- Practice address
- 17487 Old Jefferson Hwy
Suite D
Prairieville, LA 70769-4043 - Phone
- (225) 744-3902
- Fax
- (225) 744-3952
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1108 | LA | MD | Chiropractor |
| 4158 | LA | MD | Sports Physician Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1108 | LA | Yes |
| Sports Physician Chiropractor | 111NS0005X | 4158 | LA |
Addresses
Primary practice location
17487 Old Jefferson Hwy
Suite D
Prairieville, LA 70769-4043
Mailing address
17487 Old Jefferson Hwy
Suite D
Prairieville, LA 70769-4043
Phone (225) 744-3902
Other providers in Prairieville, LA
- Aleshia A Borskey
- Bourgeois Physical Therapy and Sports Rehab LLC
- Breanne Bourgeois
- Christian B Bourgeois
- Shelby Lynn Bourgeois
- Karsyn McCall Bowen
- Kennedy Boxie
- Keuna Bradford
- Patricia Gayle Bradford
- Silvia Brautigam-Martinez
All providers in Prairieville, LA · Chiropractor in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.