Provider Demographics
NPI:1154915908
Name:DEFATTA, ERIN PAIGE (DC)
Entity type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:PAIGE
Last Name:DEFATTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 FONTAINBLEAU DR # D1
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6518
Mailing Address - Country:US
Mailing Address - Phone:985-400-5300
Mailing Address - Fax:
Practice Address - Street 1:102 FONTAINBLEAU DR # D1
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6518
Practice Address - Country:US
Practice Address - Phone:985-400-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor