Provider Demographics
NPI:1427242189
Name:OAKDALE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:OAKDALE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-335-1000
Mailing Address - Street 1:122 EAST 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463
Mailing Address - Country:US
Mailing Address - Phone:318-335-1000
Mailing Address - Fax:318-335-1006
Practice Address - Street 1:122 EAST 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463
Practice Address - Country:US
Practice Address - Phone:318-335-1000
Practice Address - Fax:318-335-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1373362Medicaid
LA1373362Medicaid
LA4H699CS54Medicare PIN