Provider Demographics
NPI:1003156357
Name:PREMIER CHIROPRACTIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:PREMIER CHIROPRACTIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:COMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-623-8157
Mailing Address - Street 1:PO BOX 14878
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71207-4878
Mailing Address - Country:US
Mailing Address - Phone:318-623-8157
Mailing Address - Fax:
Practice Address - Street 1:1112 OLIVER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5714
Practice Address - Country:US
Practice Address - Phone:318-512-4951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA310086Medicare PIN