Provider Demographics
NPI:1801346135
Name:REFINING ESSENTIALS LLC
Entity type:Organization
Organization Name:REFINING ESSENTIALS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-951-2108
Mailing Address - Street 1:69282 HIGHWAY 59 STE 4
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-7676
Mailing Address - Country:US
Mailing Address - Phone:985-951-2020
Mailing Address - Fax:985-951-2025
Practice Address - Street 1:69282 HIGHWAY 59 STE 4
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7676
Practice Address - Country:US
Practice Address - Phone:985-951-2020
Practice Address - Fax:985-951-2025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REFINING ESSENTIALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-11
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA344494ZJV4Medicare PIN