Provider Demographics
NPI:1114071099
Name:MROSKI CHIROPRACTIC APC
Entity Type:Organization
Organization Name:MROSKI CHIROPRACTIC APC
Other - Org Name:NORTHSHORE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:MROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-624-2971
Mailing Address - Street 1:1551 GIROD STREET
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448
Mailing Address - Country:US
Mailing Address - Phone:985-624-2971
Mailing Address - Fax:985-624-2972
Practice Address - Street 1:1551 GIROD STREET
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448
Practice Address - Country:US
Practice Address - Phone:985-624-2971
Practice Address - Fax:985-624-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CP73Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER