Provider Demographics
NPI:1518139005
Name:O'NEAL CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:O'NEAL CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-377-1351
Mailing Address - Street 1:1611 JIMMIE DAVIS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4556
Mailing Address - Country:US
Mailing Address - Phone:318-752-1201
Mailing Address - Fax:318-752-1203
Practice Address - Street 1:1611 JIMMIE DAVIS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4556
Practice Address - Country:US
Practice Address - Phone:318-752-1201
Practice Address - Fax:318-752-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CH81Medicare PIN