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General NPI Number Information
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NPI Number | 1023833134
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Entity Type | Organization
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Legal Business Name | SOURCE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 2443 RICE CAPITOL PKWY. SUITE D
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City | CROWLEY
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State | LA
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Zip | 70526
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Country | US
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Telephone | 337-550-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 179 GRANDE RUE
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City | CHURCH POINT
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State | LA
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Zip | 70525-5048
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Country | US
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Telephone | 337-550-9981
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. TANNER JOSEPH HEBERT
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Credential | DC
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Telephone | 337-550-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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