Provider Demographics
NPI:1730311085
Name:BRUCE A. MAERHOFERDCAPC
Entity Type:Organization
Organization Name:BRUCE A. MAERHOFERDCAPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOP/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAERHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-478-1186
Mailing Address - Street 1:4413 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4311
Mailing Address - Country:US
Mailing Address - Phone:337-478-1186
Mailing Address - Fax:
Practice Address - Street 1:4413 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4311
Practice Address - Country:US
Practice Address - Phone:337-478-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty