Provider Demographics
NPI:1598246795
Name:ENLIGHTENED CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ENLIGHTENED CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VITENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-259-0780
Mailing Address - Street 1:22 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-6643
Mailing Address - Country:US
Mailing Address - Phone:504-259-0780
Mailing Address - Fax:
Practice Address - Street 1:2701 AIRLINE DR STE E
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7213
Practice Address - Country:US
Practice Address - Phone:504-323-4956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty