Provider Demographics
NPI:1497231633
Name:BRANDON RACCA LLC
Entity Type:Organization
Organization Name:BRANDON RACCA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RACCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-502-5303
Mailing Address - Street 1:1210 E MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4756
Mailing Address - Country:US
Mailing Address - Phone:337-502-5303
Mailing Address - Fax:337-479-2791
Practice Address - Street 1:1210 E MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4756
Practice Address - Country:US
Practice Address - Phone:337-502-5303
Practice Address - Fax:337-479-2791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty