Provider Demographics
NPI:1134327364
Name:JEFF DAVIS CHIROPRACTIC CLINCI
Entity Type:Organization
Organization Name:JEFF DAVIS CHIROPRACTIC CLINCI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CANON
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-824-6166
Mailing Address - Street 1:214 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-5810
Mailing Address - Country:US
Mailing Address - Phone:337-824-6166
Mailing Address - Fax:
Practice Address - Street 1:214 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-5810
Practice Address - Country:US
Practice Address - Phone:337-824-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA844261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center