Provider Demographics
NPI:1114128444
Name:CHAUDARY, IRSHAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:IRSHAN
Middle Name:M
Last Name:CHAUDARY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5532
Mailing Address - Country:US
Mailing Address - Phone:337-478-5634
Mailing Address - Fax:337-478-5872
Practice Address - Street 1:708 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5532
Practice Address - Country:US
Practice Address - Phone:337-478-5634
Practice Address - Fax:337-478-5872
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor