Provider Demographics
NPI:1063757714
Name:DR CAROLE LESSARD CHIROPRACTOR LLC
Entity type:Organization
Organization Name:DR CAROLE LESSARD CHIROPRACTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:LOGUE
Authorized Official - Last Name:LESSARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-496-7246
Mailing Address - Street 1:815 GUERDAT RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-2836
Mailing Address - Country:US
Mailing Address - Phone:860-496-7246
Mailing Address - Fax:860-496-0553
Practice Address - Street 1:815 GUERDAT RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-2836
Practice Address - Country:US
Practice Address - Phone:860-496-7246
Practice Address - Fax:860-496-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 1154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty