Provider Demographics
NPI:1265922421
Name:HUB CITY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HUB CITY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:PREVOST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-565-7140
Mailing Address - Street 1:2111 W PINHOOK RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-1504
Mailing Address - Country:US
Mailing Address - Phone:337-565-7140
Mailing Address - Fax:
Practice Address - Street 1:217 W BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6110
Practice Address - Country:US
Practice Address - Phone:337-565-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1393261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center