Provider Demographics
NPI:1326712308
Name:RYAN J VIDRINE LLC
Entity Type:Organization
Organization Name:RYAN J VIDRINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIDRINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-412-8538
Mailing Address - Street 1:326 SETTLERS TRACE BLVD # 201-C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6091
Mailing Address - Country:US
Mailing Address - Phone:337-412-8538
Mailing Address - Fax:
Practice Address - Street 1:326 SETTLERS TRACE BLVD # 201-C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6091
Practice Address - Country:US
Practice Address - Phone:337-412-8538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty