Individual
DR. BENJAMIN TODD THIBODEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1501 REES ST, BREAUX BRIDGE, LA 70517-4309
(337) 332-2225
(337) 332-6097
Mailing address
PO BOX 97, BREAUX BRIDGE, LA 70517-0097
(337) 945-7115
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1278
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295832624
BLUE CROSS BLUE SHIELD
LA
Enumeration date
09/20/2006
Last updated
12/07/2011
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