Provider Demographics
NPI:1255502357
Name:DNA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DNA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-626-7795
Mailing Address - Street 1:235 W FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3056
Mailing Address - Country:US
Mailing Address - Phone:985-626-7795
Mailing Address - Fax:
Practice Address - Street 1:235 W FLORIDA ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3056
Practice Address - Country:US
Practice Address - Phone:985-626-7795
Practice Address - Fax:985-626-7462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty