Organization
ROBERT E LAVICTOIRE DC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT EDWARD LAVICTOIRE DC (PRESIDENT)
(252) 946-0148
Entity
Organization
Contact information
Practice address
818 W 5TH STREET, WASHINGTON, NC 27889
(252) 946-0148
(252) 946-0148
Mailing address
818 W 5TH ST, WASHINGTON, NC 27889-4204
(252) 946-0148
(252) 946-0148
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1499
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08551
BLUE CROSS BLUE SHIELD
—
01
—
244499A
MEDICARE IND PTAN
NC
01
—
244499B
MEDICARE GROUP PTAN
NC
05
—
8908551
—
NC
Enumeration date
08/29/2007
Last updated
11/11/2008
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