Provider Demographics
NPI:1518911585
Name:MARKSVILLE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MARKSVILLE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:VERMAELEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-240-7770
Mailing Address - Street 1:410 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2411
Mailing Address - Country:US
Mailing Address - Phone:318-240-7771
Mailing Address - Fax:318-240-7759
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2411
Practice Address - Country:US
Practice Address - Phone:318-240-7771
Practice Address - Fax:318-240-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty