Provider Demographics
NPI:1598175564
Name:CHIROPRACTIC SPA, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC SPA, LLC
Other - Org Name:MELISSA RAIGAN SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-674-5855
Mailing Address - Street 1:1120 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3429
Mailing Address - Country:US
Mailing Address - Phone:985-674-5855
Mailing Address - Fax:985-674-5854
Practice Address - Street 1:1120 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3429
Practice Address - Country:US
Practice Address - Phone:985-674-5855
Practice Address - Fax:985-674-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty