1417987314 NPI number — ABSHIRE CHIROPRACTIC, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417987314 NPI number — ABSHIRE CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSHIRE CHIROPRACTIC, LLC
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:
1417987314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAURICE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70555-0490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-898-0522
Provider Business Mailing Address Fax Number:
337-898-2025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7992 MAURICE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAURICE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70555-0490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-898-0522
Provider Business Practice Location Address Fax Number:
337-898-2025
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABSHIRE
Authorized Official First Name:
ROWDY
Authorized Official Middle Name:
CAIN
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
337-898-0522

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1382 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 810770090 . This is a "PHCS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 4366769750 . This is a "BLUE CROSS/SHIELD LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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