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General NPI Number Information
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NPI Number | 1750927711
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Entity Type | Organization
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Legal Business Name | NA
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 3436 MAGAZINE ST # 7109
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City | NEW ORLEANS
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State | LA
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Zip | 70115-2413
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Country | US
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Telephone | 504-224-9678
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Fax |
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Provider Business Mailing Address
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Address Line | 3436 MAGAZINE ST
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City | NEW ORLEANS
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State | LA
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Zip | 70115-2480
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Country | US
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Telephone | 555-555-5555
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NA NA
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Credential | DC
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Telephone | 555-555-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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