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General NPI Number Information
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NPI Number | 1366590648
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Entity Type | Organization
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Legal Business Name | BROUSSARD CHIROPRACTIC CENTER, INC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 331 HOSPITAL RD
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City | NEW ROADS
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State | LA
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Zip | 70760-2622
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Country | US
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Telephone | 225-618-8016
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Fax | 225-618-8028
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Provider Business Mailing Address
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Address Line | 331 HOSPITAL RD
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City | NEW ROADS
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State | LA
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Zip | 70760-2622
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Country | US
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Telephone | 225-618-8016
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Fax | 225-618-8028
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. LATRESIA GRACE BROUSSARD
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Credential | DC
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Telephone | 225-618-8016
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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 | 1307
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License Number State | LA
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