Provider Demographics
NPI:1447360219
Name:LEBEOUF, ANICE M (DC)
Entity type:Individual
Prefix:DR
First Name:ANICE
Middle Name:M
Last Name:LEBEOUF
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 1:604 DALE LN
Mailing Address - Street 2:
Mailing Address - City:DALE
Mailing Address - State:TX
Mailing Address - Zip Code:78616-2843
Mailing Address - Country:US
Mailing Address - Phone:512-913-3993
Mailing Address - Fax:512-467-1101
Practice Address - Street 1:211 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2647
Practice Address - Country:US
Practice Address - Phone:512-913-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X2071OtherBCBS INDIVIDUAL ID
TX321889302Medicaid
TX288606YL5EMedicare PIN