Provider Demographics
NPI:1316045826
Name:TASSIN, PAUL STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEPHEN
Last Name:TASSIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 42ND ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2196
Mailing Address - Country:US
Mailing Address - Phone:504-443-6000
Mailing Address - Fax:
Practice Address - Street 1:2001 42ND ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2196
Practice Address - Country:US
Practice Address - Phone:504-443-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA72-1313922OtherTAX ID
LA1669636Medicaid
LA3284FOtherBLUE CROSS
LA5T278Medicare ID - Type Unspecified
LA1669636Medicaid