Provider Demographics
NPI: | 1164701520 |
---|---|
Name: | ACADIAN CHIROPRCTIC AND REHAB LLC |
Entity Type: | Organization |
Organization Name: | ACADIAN CHIROPRCTIC AND REHAB LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JASON |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | PELLEGRIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 985-446-0062 |
Mailing Address - Street 1: | 500 E 7TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | THIBODAUX |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70301-3615 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 985-446-0062 |
Mailing Address - Fax: | 985-447-0079 |
Practice Address - Street 1: | 500 E 7TH ST |
Practice Address - Street 2: | |
Practice Address - City: | THIBODAUX |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70301-3615 |
Practice Address - Country: | US |
Practice Address - Phone: | 985-446-0062 |
Practice Address - Fax: | 985-447-0079 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-08-16 |
Last Update Date: | 2011-08-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | 1573 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |