Provider Demographics
NPI:1124535802
Name:BOZEMAN, CANDACE FAIRCHILD (DC)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:FAIRCHILD
Last Name:BOZEMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:CANDACE
Other - Middle Name:A
Other - Last Name:FAIRCHILD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:26509 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6550
Mailing Address - Country:US
Mailing Address - Phone:225-324-4308
Mailing Address - Fax:
Practice Address - Street 1:27999 OLD STH WALKER RD STE B
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-6048
Practice Address - Country:US
Practice Address - Phone:225-271-4083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor