Provider Demographics
NPI:1407236656
Name:HARGRAVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HARGRAVE CHIROPRACTIC LLC
Other - Org Name:HARGRAVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-258-2945
Mailing Address - Street 1:111 PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-5501
Mailing Address - Country:US
Mailing Address - Phone:337-258-2945
Mailing Address - Fax:
Practice Address - Street 1:404 WESTGATE RD # B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2719
Practice Address - Country:US
Practice Address - Phone:337-258-2945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty