Provider Demographics
NPI:1578835906
Name:ROBERT R DALE, LLC
Entity Type:Organization
Organization Name:ROBERT R DALE, LLC
Other - Org Name:RIVER PARISHES CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-652-7904
Mailing Address - Street 1:1108 W AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3717
Mailing Address - Country:US
Mailing Address - Phone:985-652-7904
Mailing Address - Fax:985-651-2981
Practice Address - Street 1:1108 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3717
Practice Address - Country:US
Practice Address - Phone:985-652-7904
Practice Address - Fax:985-651-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1953512Medicaid
LA1953512Medicaid