Provider Demographics
NPI:1790829414
Name:J. SCOTT CALDWELL, D. C., A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:J. SCOTT CALDWELL, D. C., A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:DOCTOR'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:318-323-9686
Mailing Address - Street 1:3107 DESOTO ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3921
Mailing Address - Country:US
Mailing Address - Phone:318-323-9686
Mailing Address - Fax:
Practice Address - Street 1:3107 DESOTO ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3921
Practice Address - Country:US
Practice Address - Phone:318-323-9686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1968889Medicaid
LA3186FOtherBLUE CROSS
LA3186FOtherBLUE CROSS
LA59344Medicare ID - Type Unspecified