Provider Demographics
NPI:1003179680
Name:EARL A. CHILDRESS, D.C., INC. (A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:EARL A. CHILDRESS, D.C., INC. (A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-878-3778
Mailing Address - Street 1:605 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-3101
Mailing Address - Country:US
Mailing Address - Phone:318-878-3778
Mailing Address - Fax:318-878-3779
Practice Address - Street 1:605 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-3101
Practice Address - Country:US
Practice Address - Phone:318-878-3778
Practice Address - Fax:318-878-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty