Provider Demographics
NPI:1912719261
Name:VAUTROT, TREY MATTHEW (DC)
Entity type:Individual
Prefix:
First Name:TREY
Middle Name:MATTHEW
Last Name:VAUTROT
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 1:2026 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5726
Mailing Address - Country:US
Mailing Address - Phone:337-948-3343
Mailing Address - Fax:337-948-4353
Practice Address - Street 1:2026 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5726
Practice Address - Country:US
Practice Address - Phone:337-948-3343
Practice Address - Fax:337-948-4353
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor