Provider Demographics
NPI:1922551951
Name:GRAVES-BLACK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GRAVES-BLACK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMECULA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES-BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-427-3405
Mailing Address - Street 1:2439 MANHATTAN BLVD
Mailing Address - Street 2:SUITE 505-1
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5328
Mailing Address - Country:US
Mailing Address - Phone:504-427-3405
Mailing Address - Fax:
Practice Address - Street 1:2439 MANHATTAN BLVD
Practice Address - Street 2:SUITE 505-1
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5328
Practice Address - Country:US
Practice Address - Phone:504-427-3405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty