Provider Demographics
NPI:1932563806
Name:ABC REHAB & CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ABC REHAB & CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:BOCHM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-258-7688
Mailing Address - Street 1:1304 BERTRAND DR
Mailing Address - Street 2:SUITE B3
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-9102
Mailing Address - Country:US
Mailing Address - Phone:337-258-7688
Mailing Address - Fax:
Practice Address - Street 1:1304 BERTRAND DR
Practice Address - Street 2:SUITE B3
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-9102
Practice Address - Country:US
Practice Address - Phone:337-258-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABC REHAB & CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-07
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty