Provider Demographics
NPI:1871855700
Name:MODERN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MODERN CHIROPRACTIC, LLC
Other - Org Name:LEBLANC SPINE AND NERVE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCESCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-889-5820
Mailing Address - Street 1:318 BERTRAND DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5636
Mailing Address - Country:US
Mailing Address - Phone:337-889-5820
Mailing Address - Fax:337-889-5821
Practice Address - Street 1:318 BERTRAND DR STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5636
Practice Address - Country:US
Practice Address - Phone:337-889-5820
Practice Address - Fax:337-889-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
LA1652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty