Provider Demographics
NPI:1457850158
Name:DYNAMIC PERFORMANCE CHIROPRACTIC OF HAMMOND
Entity Type:Organization
Organization Name:DYNAMIC PERFORMANCE CHIROPRACTIC OF HAMMOND
Other - Org Name:MSDB INVESTMENTS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-400-1633
Mailing Address - Street 1:17557 OLD JEFFERSON HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769
Mailing Address - Country:US
Mailing Address - Phone:225-402-0260
Mailing Address - Fax:225-744-8201
Practice Address - Street 1:1330 SOUTH MAGNOLIA
Practice Address - Street 2:SUITE B
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:225-402-0260
Practice Address - Fax:225-744-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty