Provider Demographics
NPI:1649584467
Name:CORMIER CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CORMIER CHIROPRACTIC CLINIC
Other - Org Name:DR. CHRIS CORMIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-456-6555
Mailing Address - Street 1:2304 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6808
Mailing Address - Country:US
Mailing Address - Phone:337-456-6555
Mailing Address - Fax:337-706-7221
Practice Address - Street 1:2304 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6808
Practice Address - Country:US
Practice Address - Phone:337-456-6555
Practice Address - Fax:337-706-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty