Provider Demographics
NPI:1194586602
Name:LACOURSIERE, HENRY NEIL (DC)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:NEIL
Last Name:LACOURSIERE
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 1:1625 W STATE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4003
Mailing Address - Country:US
Mailing Address - Phone:208-336-0017
Mailing Address - Fax:
Practice Address - Street 1:1625 W STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4003
Practice Address - Country:US
Practice Address - Phone:208-336-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor