Provider Demographics
NPI:1760788780
Name:PRATT FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PRATT FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-406-1988
Mailing Address - Street 1:3213 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3763
Mailing Address - Country:US
Mailing Address - Phone:337-406-1988
Mailing Address - Fax:337-406-1908
Practice Address - Street 1:3213 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3763
Practice Address - Country:US
Practice Address - Phone:337-406-1988
Practice Address - Fax:337-406-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1433144Medicaid
LAU74978Medicare UPIN
LA1433144Medicaid