Healthcare Provider Details

I. General information

NPI: 1679705834
Provider Name (Legal Business Name): BENJAMIN J DICHIARA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PARIS AVE
METAIRIE LA
70005-3018
US

IV. Provider business mailing address

1018 WHITETAIL DR
MANDEVILLE LA
70448-1996
US

V. Phone/Fax

Practice location:
  • Phone: 504-321-0411
  • Fax: 504-321-0412
Mailing address:
  • Phone: 504-321-0411
  • Fax: 504-321-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number1518
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: