Provider Demographics
NPI:1104894591
Name:PEGUES, FRANK LESLIE (DC)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:LESLIE
Last Name:PEGUES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 LOBDELL AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6318
Mailing Address - Country:US
Mailing Address - Phone:225-924-6742
Mailing Address - Fax:
Practice Address - Street 1:656 LOBDELL AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6318
Practice Address - Country:US
Practice Address - Phone:225-924-6742
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA122111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19949Medicare UPIN
LA59149Medicare ID - Type Unspecified