Provider Demographics
NPI:1528110913
Name:MCGRAW, JOHN DAVID (DC,CCSP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:MCGRAW
Suffix:
Gender:M
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3028
Mailing Address - Country:US
Mailing Address - Phone:318-256-6767
Mailing Address - Fax:318-256-0793
Practice Address - Street 1:565 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3028
Practice Address - Country:US
Practice Address - Phone:318-256-6767
Practice Address - Fax:318-256-0793
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1251111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721511988OtherTAX ID
LA4B986Medicare ID - Type Unspecified
LA721511988OtherTAX ID