Provider Demographics
NPI:1750331716
Name:CHIROPRACTIC CENTER FOR PAIN AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER FOR PAIN AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:THIGPEN
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:337-562-0817
Mailing Address - Street 1:PO BOX 2146
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-2146
Mailing Address - Country:US
Mailing Address - Phone:337-562-0817
Mailing Address - Fax:337-479-2391
Practice Address - Street 1:418 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1704
Practice Address - Country:US
Practice Address - Phone:337-562-0817
Practice Address - Fax:337-479-2391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CT04Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER