Provider Demographics
NPI:1588297303
Name:MONCEAUX, VIVIAN CLAIRE MILLER (DC)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:CLAIRE MILLER
Last Name:MONCEAUX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 BAYOU PINES EAST DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-421-0010
Mailing Address - Fax:337-421-0032
Practice Address - Street 1:780 BAYOU PINES EAST DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-421-0010
Practice Address - Fax:337-421-0032
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor