Provider Demographics
NPI:1275720302
Name:ROLLETTE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ROLLETTE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-345-9504
Mailing Address - Street 1:2108 RUE SIMONE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5728
Mailing Address - Country:US
Mailing Address - Phone:985-345-9504
Mailing Address - Fax:
Practice Address - Street 1:2108 RUE SIMONE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5728
Practice Address - Country:US
Practice Address - Phone:985-345-9504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U20490Medicare UPIN
5C032Medicare PIN