Provider Demographics
NPI:1710178579
Name:VASCONCELLOS CHIROPRACTIC
Entity Type:Organization
Organization Name:VASCONCELLOS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-835-3736
Mailing Address - Street 1:722 PHOSPHOR AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2727
Mailing Address - Country:US
Mailing Address - Phone:504-835-3736
Mailing Address - Fax:504-832-8149
Practice Address - Street 1:722 PHOSPHOR AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2727
Practice Address - Country:US
Practice Address - Phone:504-835-3736
Practice Address - Fax:504-832-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG1381OtherBLUE CROSS
LAG1381OtherBLUE CROSS