Provider Demographics
NPI:1508487364
Name:CALCASIEU CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CALCASIEU CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-794-7793
Mailing Address - Street 1:PO BOX 12826
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70612-2826
Mailing Address - Country:US
Mailing Address - Phone:337-794-7793
Mailing Address - Fax:
Practice Address - Street 1:634 N HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5348
Practice Address - Country:US
Practice Address - Phone:337-794-7793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty