Provider Demographics
NPI:1730677113
Name:CENTER FOR CHIROPRACTIC AND REHABILITATION SULPHUR LLC
Entity Type:Organization
Organization Name:CENTER FOR CHIROPRACTIC AND REHABILITATION SULPHUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RACCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-888-3144
Mailing Address - Street 1:671 S POST OAK RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-3631
Mailing Address - Country:US
Mailing Address - Phone:337-888-3144
Mailing Address - Fax:337-888-3196
Practice Address - Street 1:671 S POST OAK RD
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-3631
Practice Address - Country:US
Practice Address - Phone:337-802-1951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty