Provider Demographics
NPI:1306018510
Name:WALTER P. CREEL, D.C., INC.
Entity type:Organization
Organization Name:WALTER P. CREEL, D.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:P
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-992-2022
Mailing Address - Street 1:PO BOX 1333
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-1333
Mailing Address - Country:US
Mailing Address - Phone:318-992-2022
Mailing Address - Fax:318-992-2037
Practice Address - Street 1:12051 HWY 84 WEST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342
Practice Address - Country:US
Practice Address - Phone:318-992-2022
Practice Address - Fax:318-992-2037
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER P. CREEL, D.C., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1955272Medicaid
LA59077Medicare PIN
LAT19914Medicare UPIN
LA1955272Medicaid