Healthcare Provider Details

I. General information

NPI: 1942347976
Provider Name (Legal Business Name): RIVER PARISHES CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 W AIRLINE HWY
LAPLACE LA
70068-3717
US

IV. Provider business mailing address

1108 W AIRLINE HWY
LAPLACE 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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number763
License Number StateLA

VIII. Authorized Official

Name: DR. ROBERT RODNEY DALE
Title or Position: OWNER LLC
Credential: DC
Phone: 985-652-7904