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General NPI Number Information
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NPI Number | 1922551951
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Entity Type | Organization
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Legal Business Name | GRAVES-BLACK CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 2439 MANHATTAN BLVD SUITE 505-1
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City | HARVEY
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State | LA
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Zip | 70058-5328
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Country | US
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Telephone | 504-427-3405
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Fax |
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Provider Business Mailing Address
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Address Line | 2439 MANHATTAN BLVD SUITE 505-1
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City | HARVEY
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State | LA
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Zip | 70058-5328
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Country | US
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Telephone | 504-427-3405
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TAMECULA GRAVES-BLACK
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Credential | D.C.
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Telephone | 504-427-3405
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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 | 1771
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License Number State | LA
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