Provider Demographics
NPI:1619312089
Name:MAGNOLIA CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:MAGNOLIA CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:H
Authorized Official - Last Name:LITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-313-4605
Mailing Address - Street 1:17278 AIRLINE HWY
Mailing Address - Street 2:STE. C
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3451
Mailing Address - Country:US
Mailing Address - Phone:225-313-4605
Mailing Address - Fax:225-313-4607
Practice Address - Street 1:17278 AIRLINE HWY
Practice Address - Street 2:STE. C
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3453
Practice Address - Country:US
Practice Address - Phone:225-313-4605
Practice Address - Fax:225-313-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty