Provider Demographics
NPI:1891176285
Name:LIAUTAUD FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LIAUTAUD FAMILY CHIROPRACTIC LLC
Other - Org Name:CHIROPRACTIC HUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LIAUTAUD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:515-848-3334
Mailing Address - Street 1:114 1/2 E MONROE ST
Mailing Address - Street 2:P.O. BOX 491
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50225-7744
Mailing Address - Country:US
Mailing Address - Phone:515-848-3334
Mailing Address - Fax:515-848-3335
Practice Address - Street 1:114 1/2 E MONROE ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:IA
Practice Address - Zip Code:50225-7744
Practice Address - Country:US
Practice Address - Phone:515-848-3334
Practice Address - Fax:515-848-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072768261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care