Provider Demographics
NPI:1871691493
Name:THERIOT, MICHAEL TODD (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:THERIOT
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 1:730 BAYOU PINES EAST DR
Mailing Address - Street 2:STE A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7184
Mailing Address - Country:US
Mailing Address - Phone:337-433-7551
Mailing Address - Fax:337-433-6378
Practice Address - Street 1:730 BAYOU PINES EAST DR
Practice Address - Street 2:STE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7184
Practice Address - Country:US
Practice Address - Phone:337-433-7551
Practice Address - Fax:337-433-6378
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1652954Medicaid
LA1652954Medicaid
LAU50725Medicare UPIN