Provider Demographics
NPI:1184991598
Name:ERIK G LEMOULLEC DC LLC
Entity type:Organization
Organization Name:ERIK G LEMOULLEC DC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:GILLES
Authorized Official - Last Name:LEMOULLEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FCAMI
Authorized Official - Phone:203-263-0411
Mailing Address - Street 1:20 SHERMAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3647
Mailing Address - Country:US
Mailing Address - Phone:203-263-0411
Mailing Address - Fax:203-841-1012
Practice Address - Street 1:3 POMPERAUG OFFICE PARK STE 103
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2287
Practice Address - Country:US
Practice Address - Phone:203-263-0411
Practice Address - Fax:203-841-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008043787Medicaid
CTD400595471OtherMEDICARE PROVIDER ID
CTD400000897OtherMEDICARE PROVIDER ID