Healthcare Provider Details

I. General information

NPI: 1326233768
Provider Name (Legal Business Name): P.C.C., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 JEFFERSON HWY
RIVER RIDGE LA
70123-3526
US

IV. Provider business mailing address

9045 JEFFERSON HWY
RIVER RIDGE LA
70123-3526
US

V. Phone/Fax

Practice location:
  • Phone: 504-737-2834
  • Fax:
Mailing address:
  • Phone: 504-737-2834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number11
License Number StateLA

VIII. Authorized Official

Name: MARILYN J PANGER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 504-737-2834