Provider Demographics
NPI:1013026772
Name:RAIFORD, TRUDY ANN (DC)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:ANN
Last Name:RAIFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 CLEARVIEW PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001
Mailing Address - Country:US
Mailing Address - Phone:504-888-1115
Mailing Address - Fax:504-888-8510
Practice Address - Street 1:1908 CLEARVIEW PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001
Practice Address - Country:US
Practice Address - Phone:504-888-1115
Practice Address - Fax:504-888-8510
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5X412Medicare ID - Type Unspecified
U69146Medicare UPIN