Provider Demographics
NPI:1265565063
Name:DR R B VANBREEMEN LTD APC
Entity type:Organization
Organization Name:DR R B VANBREEMEN LTD APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BUCKLEY
Authorized Official - Last Name:VANBREEMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-647-8712
Mailing Address - Street 1:2107 S BURNSIDE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4665
Mailing Address - Country:US
Mailing Address - Phone:225-647-8712
Mailing Address - Fax:225-647-8718
Practice Address - Street 1:2107 S BURNSIDE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4665
Practice Address - Country:US
Practice Address - Phone:225-647-8712
Practice Address - Fax:225-647-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty