Healthcare Provider Details

I. General information

NPI: 1912522772
Provider Name (Legal Business Name): SAMANTHA MEGAN LOPEZ D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SW RAILROAD AVE APT 1
PONCHATOULA LA
70454-3342
US

IV. Provider business mailing address

20259 CAMDEN LN
HAMMOND LA
70403-0558
US

V. Phone/Fax

Practice location:
  • Phone: 985-351-0849
  • Fax:
Mailing address:
  • Phone: 985-351-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1909
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: