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General NPI Number Information
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NPI Number | 1619312089
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Entity Type | Organization
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Legal Business Name | MAGNOLIA CHIROPRACTIC CENTER, LLC
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 17278 AIRLINE HWY STE. C
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3453
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Country | US
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Telephone | 225-313-4605
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Fax | 225-313-4607
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Provider Business Mailing Address
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Address Line | 17278 AIRLINE HWY STE. C
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3451
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Country | US
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Telephone | 225-313-4605
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Fax | 225-313-4607
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. TODD H LITTEN
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Credential | D.C.
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Telephone | 225-313-4605
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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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