Provider Demographics
NPI:1063718138
Name:STEWART B. FRESH, DC, LLC
Entity type:Organization
Organization Name:STEWART B. FRESH, DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRESH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-259-7774
Mailing Address - Street 1:9 STARBRUSH CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7246
Mailing Address - Country:US
Mailing Address - Phone:985-259-7774
Mailing Address - Fax:985-259-7775
Practice Address - Street 1:9 STARBRUSH CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7246
Practice Address - Country:US
Practice Address - Phone:985-259-7774
Practice Address - Fax:985-259-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
LA1405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty