Provider Demographics
NPI:1518242296
Name:EASTMAN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:EASTMAN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-436-3145
Mailing Address - Street 1:P.O. BOX 277
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:LA
Mailing Address - Zip Code:70669
Mailing Address - Country:US
Mailing Address - Phone:337-436-3145
Mailing Address - Fax:337-436-5435
Practice Address - Street 1:902 SAMPSON STREET
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:LA
Practice Address - Zip Code:70669
Practice Address - Country:US
Practice Address - Phone:337-436-3145
Practice Address - Fax:337-436-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty