Provider Demographics
NPI:1588863567
Name:PREWITT CHIROPRACTIC CLINIC A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:PREWITT CHIROPRACTIC CLINIC A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PREWITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-774-5566
Mailing Address - Street 1:3121 VAN BUREN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3464
Mailing Address - Country:US
Mailing Address - Phone:225-774-5566
Mailing Address - Fax:225-774-8855
Practice Address - Street 1:3121 VAN BUREN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3464
Practice Address - Country:US
Practice Address - Phone:225-774-5566
Practice Address - Fax:225-774-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3162FOtherBLUE CROSS BLUE SHIELD
LA5131436OtherAETNA
LA4770113OtherCIGNA
LA1955604Medicaid
LA1955604Medicaid
LA5D728Medicare PIN