Provider Demographics
NPI:1114651692
Name:ADAM REEVES DC A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:ADAM REEVES DC A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-523-4688
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-0631
Mailing Address - Country:US
Mailing Address - Phone:225-473-3990
Mailing Address - Fax:225-473-3992
Practice Address - Street 1:108 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-4337
Practice Address - Country:US
Practice Address - Phone:225-473-3990
Practice Address - Fax:225-473-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty