Provider Demographics
NPI:1528200862
Name:DR. BRYAN J. DUFRENE
Entity Type:Organization
Organization Name:DR. BRYAN J. DUFRENE
Other - Org Name:WHOLE BODY HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUFRENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-537-7187
Mailing Address - Street 1:3742 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-3141
Mailing Address - Country:US
Mailing Address - Phone:985-537-7187
Mailing Address - Fax:985-537-7188
Practice Address - Street 1:3742 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-3141
Practice Address - Country:US
Practice Address - Phone:985-537-7187
Practice Address - Fax:985-537-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA656111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2183AOtherBLUE CROSS/BLUE SHEILD
LA2183AOtherBLUE CROSS/BLUE SHEILD
LAT-20096Medicare UPIN