=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942347976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVER PARISHES CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 12/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1108 W AIRLINE HWY
-----------------------------------------------------
City | LAPLACE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70068-3717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-652-7904
-----------------------------------------------------
Fax | 985-651-2981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1108 W AIRLINE HWY
-----------------------------------------------------
City | LAPLACE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70068-3717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-652-7904
-----------------------------------------------------
Fax | 985-651-2981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER LLC
-----------------------------------------------------
Name | DR. ROBERT RODNEY DALE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 985-652-7904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 763
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------