Provider Demographics
NPI:1104952720
Name:MASSE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:MASSE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:MASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-439-9306
Mailing Address - Street 1:4100 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4637
Mailing Address - Country:US
Mailing Address - Phone:337-439-9306
Mailing Address - Fax:337-310-4042
Practice Address - Street 1:4100 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4637
Practice Address - Country:US
Practice Address - Phone:337-439-9306
Practice Address - Fax:337-310-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CE00Medicare ID - Type UnspecifiedCLINIC GROUP NUMBER