Provider Demographics
NPI:1043652324
Name:DUHON CALCASIEU SPINAL CARE A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:DUHON CALCASIEU SPINAL CARE A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:CALCASIEU SPINAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DUHON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-474-7700
Mailing Address - Street 1:2118 E PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7876
Mailing Address - Country:US
Mailing Address - Phone:337-474-7700
Mailing Address - Fax:337-474-7705
Practice Address - Street 1:2118 E PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7876
Practice Address - Country:US
Practice Address - Phone:337-474-7700
Practice Address - Fax:337-474-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6663111N00000X
LA1043111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU55672Medicaid
LA1386716660OtherINDIVIDUAL NPI
LA1659371Medicaid
LAU55672Medicaid
LA5T709CY23Medicare PIN