Provider Demographics
NPI:1871826248
Name:WEST BROAD CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:WEST BROAD CHIROPRACTIC, INC.
Other - Org Name:RAIDER FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BUFFIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-467-0302
Mailing Address - Street 1:1919 VETERANS BOULEVARD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:513 E RICH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5376
Practice Address - Country:US
Practice Address - Phone:614-469-1753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty