MEDICARE: FAMILY CHIROPRACTIC CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20370	OTHER	LA	BLUE CROSS

General Provider Information

NPI Number	:	1194940510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	3855 N ACADIAN THRUWAY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-5724
Country	:	US
Telephone Number	:	225-356-4449
Fax Number	:	225-355-3213

Provider Business Practice Location Address
First Line	:	3855 N ACADIAN THRUWAY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-5724
Country	:	US
Telephone Number	:	225-356-4449
Fax Number	:	225-355-3213

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS CHARLES PLANTZ
Credential	:	D.C.
Telephone Number	:	225-356-4449

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	08/22/2020

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