1063739571 NPI number — RAYMOND CHIROPRACTIC PA

Table of content: DR. CHEYENNE NELLIE LEBLANC AUD (NPI 1912481573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063739571 NPI number — RAYMOND CHIROPRACTIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAYMOND CHIROPRACTIC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063739571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6333 E MOCKINGBIRD LN
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75214-2692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-821-2525
Provider Business Mailing Address Fax Number:
214-821-2548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6333 E MOCKINGBIRD LN
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75214-2692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-821-2525
Provider Business Practice Location Address Fax Number:
214-821-2548
Provider Enumeration Date:
04/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RAYMOND
Authorized Official First Name:
MURRAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
214-821-2525

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8217 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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