Provider Demographics
NPI:1073689881
Name:UNDERWOOD UNDERWOOD LLC
Entity Type:Organization
Organization Name:UNDERWOOD UNDERWOOD LLC
Other - Org Name:UNDERWOOD CHIROPRACTIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC CCSP
Authorized Official - Phone:225-293-1700
Mailing Address - Street 1:11851 COURSEY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816
Mailing Address - Country:US
Mailing Address - Phone:225-293-1700
Mailing Address - Fax:225-293-1774
Practice Address - Street 1:11851 COURSEY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-293-1700
Practice Address - Fax:225-293-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1160111N00000X
LA304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG3181OtherBLUE CROSS
LAG3179OtherBLUE CROSS
LA59310Medicare PIN
LAG3181OtherBLUE CROSS