Healthcare Provider Details

I. General information

NPI: 1750783213
Provider Name (Legal Business Name): LA TCHOPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 TCHOUPITOULAS ST
NEW ORLEANS LA
70115-1207
US

IV. Provider business mailing address

3305 TCHOUPITOULAS ST
NEW ORLEANS LA
70115-1207
US

V. Phone/Fax

Practice location:
  • Phone: 504-620-5606
  • Fax: 504-322-2213
Mailing address:
  • Phone: 504-620-5606
  • Fax: 504-322-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1544
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD023687
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number08931
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number984
License Number StateLA

VIII. Authorized Official

Name: JENI WHITFIELD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 504-620-5606