Provider Demographics
NPI:1821439399
Name:L.I.F.T. CHIROPRACTIC
Entity Type:Organization
Organization Name:L.I.F.T. CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:QUOC
Authorized Official - Middle Name:THAI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-218-4891
Mailing Address - Street 1:2201 BARATARIA BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-218-4891
Mailing Address - Fax:504-218-4892
Practice Address - Street 1:2201 BARATARIA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-5566
Practice Address - Country:US
Practice Address - Phone:504-218-4891
Practice Address - Fax:504-218-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1608332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies