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General NPI Number Information
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NPI Number | 1912344169
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Entity Type | Organization
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Legal Business Name | CORE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 16573 AIRLINE HWY # B
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3431
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Country | US
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Telephone | 985-513-0874
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Fax |
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Provider Business Mailing Address
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Address Line | 223 RUE DE BEAUVILLE
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City | NAPOLEONVILLE
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State | LA
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Zip | 70390-2319
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Country | US
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Telephone | 985-513-0874
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JOSHUA BLANCHARD
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Credential | DC
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Telephone | 985-513-0874
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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 | 1666
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License Number State | LA
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