Provider Demographics
NPI:1548393473
Name:PULLIAM CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:PULLIAM CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-649-0023
Mailing Address - Street 1:PO BOX 6776
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70469-6776
Mailing Address - Country:US
Mailing Address - Phone:985-649-0023
Mailing Address - Fax:
Practice Address - Street 1:2055 GAUSE BLVD E
Practice Address - Street 2:SUITE 300
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5432
Practice Address - Country:US
Practice Address - Phone:985-649-0023
Practice Address - Fax:985-661-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3258AOtherBLUE CROSS BLUE SHIELD LA
LAH6150OtherBLUE CROSS BLUE SHIELD LA
LAH6150OtherBLUE CROSS BLUE SHIELD LA