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General NPI Number Information
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NPI Number | 1992980189
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CLINIC OF GRETNA
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 548 LAPALCO BLVD
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City | GRETNA
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State | LA
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Zip | 70056-7305
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Country | US
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Telephone | 504-392-8000
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Fax | 504-392-9252
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Provider Business Mailing Address
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Address Line | 548 LAPALCO BLVD
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City | GRETNA
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State | LA
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Zip | 70056-7305
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Country | US
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Telephone | 504-392-8000
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Fax | 504-392-9252
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Authorized Official
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Title or Position | PRESIDENT
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Name | CELINE L WILLIAMSON
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Credential | DR. OF CHIROPRACTIC
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Telephone | 504-392-8000
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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 | 655
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License Number State | LA
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