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General NPI Number Information
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NPI Number | 1447593975
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Entity Type | Organization
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Legal Business Name | HEALTH RESOURCE LLC
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 2105 RUE SIMONE SUITE B
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City | HAMMOND
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State | LA
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Zip | 70403-5727
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Country | US
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Telephone | 985-956-7400
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Fax | 985-956-7402
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Provider Business Mailing Address
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Address Line | 2105 RUE SIMONE SUITE B
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City | HAMMOND
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State | LA
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Zip | 70403-5727
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Country | US
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Telephone | 985-956-7400
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Fax | 985-956-7402
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDON MAHL
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Credential | D.C.
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Telephone | 985-956-7400
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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 | 1553
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License Number State | LA
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