Provider Demographics
NPI:1285958876
Name:HAYDEL FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:HAYDEL FAMILY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYDEL
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:985-346-4844
Mailing Address - Street 1:4752 HIGHWAY 311
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2810
Mailing Address - Country:US
Mailing Address - Phone:985-346-4844
Mailing Address - Fax:985-346-4845
Practice Address - Street 1:4752 HIGHWAY 311
Practice Address - Street 2:SUITE 104
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2810
Practice Address - Country:US
Practice Address - Phone:985-346-4844
Practice Address - Fax:985-346-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty