MEDICARE: NA

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1750927711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NA

Provider Business Mailing Address
First Line	:	3436 MAGAZINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-2480
Country	:	US
Telephone Number	:	555-555-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 MAGAZINE ST # 7109
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-2413
Country	:	US
Telephone Number	:	504-224-9678
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. NA NA
Credential	:	DC
Telephone Number	:	555-555-5555

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	02/11/2026

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Directions to “NA ” Practice Location

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