Healthcare Provider Details

I. General information

NPI: 1982007092
Provider Name (Legal Business Name): MCGRAW CHIROPRACTIC CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 MAIN ST
MANY LA
71449-3028
US

IV. Provider business mailing address

565 MAIN ST
MANY LA
71449-3028
US

V. Phone/Fax

Practice location:
  • Phone: 318-256-6767
  • Fax:
Mailing address:
  • Phone: 318-256-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1251
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1251
License Number StateLA

VIII. Authorized Official

Name: JOHN DAVID MCGRAW
Title or Position: OWNER
Credential: D.C., CCSP
Phone: 318-256-6767