Healthcare Provider Details

I. General information

NPI: 1043145782
Provider Name (Legal Business Name): CHRISTOPHER JACQUE DELANEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARK WEST DR STE A
SCOTT LA
70583-8902
US

IV. Provider business mailing address

PO BOX 552
GRAND COTEAU LA
70541-0552
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-4882
  • Fax: 337-504-5262
Mailing address:
  • Phone: 337-557-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9905
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: