Provider Demographics
NPI:1215008685
Name:ROUGEUX, LAWRENCE D (BS MA DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:D
Last Name:ROUGEUX
Suffix:
Gender:M
Credentials:BS MA DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 EAST 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1727
Mailing Address - Country:US
Mailing Address - Phone:814-456-4200
Mailing Address - Fax:814-456-4200
Practice Address - Street 1:715 EAST 37TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1727
Practice Address - Country:US
Practice Address - Phone:814-456-4200
Practice Address - Fax:814-456-4200
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003047L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010191140001Medicaid
PA341803OtherHIGHMARK BS BC
188037Medicare ID - Type Unspecified
PA341803OtherHIGHMARK BS BC