Provider Demographics
NPI:1912522772
Name:LOPEZ, SAMANTHA MEGAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MEGAN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-4225
Mailing Address - Country:US
Mailing Address - Phone:985-542-1640
Mailing Address - Fax:985-542-3171
Practice Address - Street 1:105 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4225
Practice Address - Country:US
Practice Address - Phone:985-542-1640
Practice Address - Fax:985-542-3171
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor