Healthcare Provider Details

I. General information

NPI: 1528110913
Provider Name (Legal Business Name): JOHN DAVID MCGRAW D.C.,CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/23/2011
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: 318-256-0793
Mailing address:
  • Phone: 318-256-6767
  • Fax: 318-256-0793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1251
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1251
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: