Provider Demographics
NPI:1518330711
Name:NEURALOGIX MANAGEMENT, LLC
Entity Type:Organization
Organization Name:NEURALOGIX MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-274-6999
Mailing Address - Street 1:2612 SEVERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5935
Mailing Address - Country:US
Mailing Address - Phone:504-491-4987
Mailing Address - Fax:
Practice Address - Street 1:1860 CHADWICK DR STE 202
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3466
Practice Address - Country:US
Practice Address - Phone:833-274-6998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory