MEDICARE: OLD TOWN CHIROP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1780737429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLD TOWN CHIROP.

Provider Business Mailing Address
First Line	:	1919 VETERANS BLVD
Second Line	:	SUITE 200
City	:	KENNER
State	:	LA
Zip	:	70062
Country	:	US
Telephone Number	:
Fax Number	:	504-467-0093

Provider Business Practice Location Address
First Line	:	3431 CLEVELAND AVE
Second Line	:	SUITE G
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2920
Country	:	US
Telephone Number	:	614-784-0002
Fax Number	:	614-784-0904

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	BUFFIE L ROME IX
Credential	:
Telephone Number	:	504-467-0302

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/22/2020

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Directions to “OLD TOWN CHIROP. ” Practice Location

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