Provider Demographics
NPI:1043481757
Name:FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-868-0037
Mailing Address - Street 1:205 BAYOU GARDENS BLVD STE E1
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-1477
Mailing Address - Country:US
Mailing Address - Phone:985-868-0037
Mailing Address - Fax:985-223-4478
Practice Address - Street 1:205 BAYOU GARDENS BLVD STE E1
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1477
Practice Address - Country:US
Practice Address - Phone:985-868-0037
Practice Address - Fax:985-223-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5639644800OtherBLUE CROSS/BLUE SHEILD
LA5D698Medicare PIN
LAU40308Medicare UPIN