Provider Demographics
NPI:1770621211
Name:MILLERVILLAGE CHIROPRACTIC CENTER,APCC
Entity type:Organization
Organization Name:MILLERVILLAGE CHIROPRACTIC CENTER,APCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-291-2626
Mailing Address - Street 1:PO BOX 40362
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70835-0362
Mailing Address - Country:US
Mailing Address - Phone:225-291-2626
Mailing Address - Fax:225-291-2626
Practice Address - Street 1:4137 S SHERWOOD FOREST BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4377
Practice Address - Country:US
Practice Address - Phone:225-291-2626
Practice Address - Fax:225-291-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty