Provider Demographics
NPI:1902181852
Name:CARAWAY-BRANCH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CARAWAY-BRANCH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:CARAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-439-9313
Mailing Address - Street 1:1200 ENTERPRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-6322
Mailing Address - Country:US
Mailing Address - Phone:337-439-9313
Mailing Address - Fax:337-439-8045
Practice Address - Street 1:1200 ENTERPRISE BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6322
Practice Address - Country:US
Practice Address - Phone:337-439-9313
Practice Address - Fax:337-439-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1378111N00000X
LA482111N00000X
LA1522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H497Medicare UPIN