Provider Demographics
NPI:1518515279
Name:BAYOU BELLE WELLNESS
Entity Type:Organization
Organization Name:BAYOU BELLE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLARS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-789-2302
Mailing Address - Street 1:200 MALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-2348
Mailing Address - Country:US
Mailing Address - Phone:318-789-2302
Mailing Address - Fax:318-855-6562
Practice Address - Street 1:108 ZEPHYR ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-789-2302
Practice Address - Fax:318-855-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty