Provider Demographics
NPI:1619280336
Name:DESTINY CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:DESTINY CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEJEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-432-1240
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-0790
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7532 HIGHWAY 23
Practice Address - Street 2:SUITE F
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-1518
Practice Address - Country:US
Practice Address - Phone:504-393-2662
Practice Address - Fax:504-393-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty