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General NPI Number Information
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NPI Number | 1396401774
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Entity Type | Organization
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Legal Business Name | HARGRAVE CHIROPRACTIC CLINIC - BREAUX BRIDGE LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 1811 REES ST UNIT C
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-4239
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Country | US
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Telephone | 337-232-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 417 WESTGATE RD
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City | LAFAYETTE
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State | LA
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Zip | 70506-2720
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Country | US
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Telephone | 337-232-6000
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Fax | 337-466-4868
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. CHRISTOPHER SETH HARGRAVE
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Credential | DC
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Telephone | 337-232-6000
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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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