Healthcare Provider Details

I. General information

NPI: 1982063350
Provider Name (Legal Business Name): HOLISTIC CHIROPRACTIC AND DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 CORMIER RD
VINTON LA
70668-6316
US

IV. Provider business mailing address

5633 CORMIER RD
VINTON LA
70668-6316
US

V. Phone/Fax

Practice location:
  • Phone: 337-324-0905
  • Fax:
Mailing address:
  • Phone: 337-324-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: CHERI NICOLE BROWN
Title or Position: OWNER
Credential:
Phone: 337-324-0905