Provider Demographics
NPI:1932164696
Name:DANIEL S BACON A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:DANIEL S BACON A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-998-3585
Mailing Address - Street 1:1035 NORTH 9 STREET
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-998-3585
Mailing Address - Fax:318-998-3588
Practice Address - Street 1:1035 NORTH 9 STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-998-3585
Practice Address - Fax:318-998-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty