Healthcare Provider Details

I. General information

NPI: 1225200199
Provider Name (Legal Business Name): MULTIDISCIPLINARY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 GAUSE BLVD E SUITE 302
SLIDELL LA
70461-4235
US

IV. Provider business mailing address

2250 GAUSE BLVD E SUITE 302
SLIDELL LA
70461-4235
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-9332
  • Fax: 985-643-9285
Mailing address:
  • Phone: 985-643-9332
  • Fax: 985-643-9285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number828
License Number StateLA

VIII. Authorized Official

Name: DR. ROBERT JOSEPH BECK
Title or Position: PRESIDENT
Credential: MADC
Phone: 985-643-9332