Provider Demographics
NPI:1144585571
Name:DALY CHIROPRACTIC & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:DALY CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DALY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:337-534-0094
Mailing Address - Street 1:101 W FARREL RD
Mailing Address - Street 2:BUILDING 5 SUITE 101
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7056
Mailing Address - Country:US
Mailing Address - Phone:337-534-0094
Mailing Address - Fax:337-534-0376
Practice Address - Street 1:101 W FARREL RD
Practice Address - Street 2:BUILDING 5 SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7056
Practice Address - Country:US
Practice Address - Phone:337-534-0094
Practice Address - Fax:337-534-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty