Healthcare Provider Details

I. General information

NPI: 1336862739
Provider Name (Legal Business Name): MIKAELA KORINNE RAY HARRINGTON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 KALISTE SALOOM RD STE B
LAFAYETTE LA
70508-4963
US

IV. Provider business mailing address

419 CROSSING NORTH ST
THIBODAUX LA
70301-6842
US

V. Phone/Fax

Practice location:
  • Phone: 231-632-6029
  • Fax:
Mailing address:
  • Phone: 231-632-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1946
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number1946
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: