Provider Demographics
NPI:1346320561
Name:GRIZZAFFI, BRAD A (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:A
Last Name:GRIZZAFFI
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 1:100 LA RUE FRANCE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3112
Mailing Address - Country:US
Mailing Address - Phone:337-237-2273
Mailing Address - Fax:
Practice Address - Street 1:100 LA RUE FRANCE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3112
Practice Address - Country:US
Practice Address - Phone:337-237-2273
Practice Address - Fax:337-237-1765
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C030Medicare ID - Type UnspecifiedMEDICARE NUMBER
LAU87956001Medicare UPIN