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General NPI Number Information
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NPI Number | 1619135308
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 2790 W CHURCH ST SUITE 4
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City | HAMMOND
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State | LA
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Zip | 70401-2860
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Country | US
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Telephone | 985-429-0005
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Fax | 985-429-0018
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Provider Business Mailing Address
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Address Line | 2790 W CHURCH ST SUITE 4
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City | HAMMOND
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State | LA
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Zip | 70401-2860
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Country | US
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Telephone | 985-429-0005
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Fax | 985-429-0018
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN/OWNER
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Name | DR. JAY MICHAEL MILLER
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Credential | D.C.
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Telephone | 985-429-0005
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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 | 1039
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License Number State | LA
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