Provider Demographics
NPI:1922183227
Name:RACCA, JAMES DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DALE
Last Name:RACCA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E. MILLER AVE.
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647-4045
Mailing Address - Country:US
Mailing Address - Phone:337-582-3508
Mailing Address - Fax:337-582-2130
Practice Address - Street 1:700 E. MILLER AVE.
Practice Address - Street 2:
Practice Address - City:IOWA
Practice Address - State:LA
Practice Address - Zip Code:70647-4045
Practice Address - Country:US
Practice Address - Phone:337-582-3508
Practice Address - Fax:337-582-2130
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA38-3719660OtherTAX ID NUMBER
LA5S778CQ83Medicare ID - Type Unspecified
LA38-3719660OtherTAX ID NUMBER
LAU34677Medicare UPIN