Provider Demographics
NPI:1164701520
Name:ACADIAN CHIROPRCTIC AND REHAB LLC
Entity type:Organization
Organization Name:ACADIAN CHIROPRCTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:PELLEGRIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-446-0062
Mailing Address - Street 1:500 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3615
Mailing Address - Country:US
Mailing Address - Phone:985-446-0062
Mailing Address - Fax:985-447-0079
Practice Address - Street 1:500 E 7TH ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3615
Practice Address - Country:US
Practice Address - Phone:985-446-0062
Practice Address - Fax:985-447-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty