Provider Demographics
NPI:1043413982
Name:BRIEN CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:BRIEN CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-331-8007
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-0698
Mailing Address - Country:US
Mailing Address - Phone:985-331-8007
Mailing Address - Fax:
Practice Address - Street 1:13601 RIVER RD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4264
Practice Address - Country:US
Practice Address - Phone:985-331-8007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty