Provider Demographics
NPI:1467472266
Name:GRAMLICH-MABOU, KARRI LEE (DC)
Entity Type:Individual
Prefix:
First Name:KARRI
Middle Name:LEE
Last Name:GRAMLICH-MABOU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12782 MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-9543
Mailing Address - Country:US
Mailing Address - Phone:318-466-3586
Mailing Address - Fax:
Practice Address - Street 1:112 PELICAN DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5372
Practice Address - Country:US
Practice Address - Phone:318-442-7831
Practice Address - Fax:318-442-7838
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor