Healthcare Provider Details

I. General information

NPI: 1316339591
Provider Name (Legal Business Name): ADRIAN CHANEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 N FOSTER DR A101
BATON ROUGE LA
70806-1871
US

IV. Provider business mailing address

660 N FOSTER DR A101
BATON ROUGE LA
70806-1871
US

V. Phone/Fax

Practice location:
  • Phone: 225-361-3687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number4496
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA4496
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: