Patrick W. Bourque, D.C., Inc

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

1108 Issued in LA

Legal business name

PATRICK W. BOURQUE, D.C., INC

Practice address

17487 Old Jefferson Hwy
Suite D
Prairieville, LA 70769-4043

Phone

(225) 744-3902

NPI assigned

Aug 17, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patrick Bourque, DC

Title

President/Ceo

Phone

(225) 744-3902

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282003200000",
    "number": "1215242045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17487 OLD JEFFERSON HWY",
            "address_2": "SUITE D",
            "city": "PRAIRIEVILLE",
            "state": "LA",
            "postal_code": "707694043",
            "telephone_number": "225-744-3902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17487 OLD JEFFERSON HWY",
            "address_2": "SUITE D",
            "city": "PRAIRIEVILLE",
            "state": "LA",
            "postal_code": "707694043",
            "telephone_number": "225-744-3902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICK W. BOURQUE, D.C., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-17",
        "last_updated": "2010-08-17",
        "status": "A",
        "authorized_official_last_name": "BOURQUE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "225-744-3902",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "LA",
            "license": "1108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Prairieville, LA by specialty
• Sports Physician Chiropractor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.