Healthcare Provider Details

I. General information

NPI: 1578835906
Provider Name (Legal Business Name): ROBERT R DALE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 W AIRLINE HWY
LA PLACE LA
70068-3717
US

IV. Provider business mailing address

1108 W AIRLINE HWY
LA PLACE LA
70068-3717
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-7904
  • Fax: 985-651-2981
Mailing address:
  • Phone: 985-652-7904
  • Fax: 985-651-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number763
License Number StateLA

VIII. Authorized Official

Name: ROBERT RODNEY DALE
Title or Position: PHYSICIAN/OWNER
Credential: DC
Phone: 985-652-7904